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Evolution of transanal total mesorectal excision for rectal cancer:from top to bottom

World Journal of Gastrointestinal Surgery 2018年第3期10卷 28-39页

作者： Sameh Hany Emile f borja de lacy deborah Susan Keller Beatriz Martin-Perez Sadir Alrawi Antonio M lacy Manish Chand department of General Surgery Mansoura Faculty of Medicine department of Surgery Hospital Clinic University of Barcelona GENIE Centre University College London department of Surgery and Interventional Sciences University College London Hospitals NHS Trusts department of Surgical Oncology Alzahra Cancer Center Al Zahra Hospital

The gold standard for curative treatment of locally advanced rectal cancer involves radical resection with a total mesorectal excision(TME). TME is the most effective treatment strategy to reduce local recurrence and improve survival outcomes regardless of the surgical platform used. However, there are associated morbidities, functional consequences, and quality of life(QoL) issues associated with TME; these risks must be considered during the modern-day multidisciplinary treatment for rectal cancer. This has led to the development of new surgical techniques to improve patient, oncologic, and QoL outcomes. In this work, we review the evolution of TME to the transanal total mesorectal excision(TaTME) through more traditional minimally invasive platforms. The review the development, safety and feasibility, proposed benefits and risks of the procedure, implementation and education models, and future direction for research and implementation of the TaTME in colorectal surgery. While satisfactory short-term results have been reported, the procedure is in its infancy, and long term outcomes and definitive results from controlled trials are pending.As evidence for safety and feasibility accumulates,structured training programs to standardize teaching,training, and safe expansion will aid the safe spread of the TaTME.

关键词： Rectal cancer Total mesorectal excision Transanal total mesorectal excision Sphincter sparing surgery Colorectal surgery

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