Penna Marta, Buchs Nicolas C, Bloemendaal Alexander L, Hompes Roel
a Department of Colorectal Surgery, Churchill Hospital , University Hospitals of Oxford , Oxford , UK.
Expert Rev Anticancer Ther. 2016 Nov;16(11):1145-1153. doi: 10.1080/14737140.2016.1240040. Epub 2016 Oct 8.
The surgical approach to total mesorectal excision (TME) for rectal cancer has undergone a substantial evolution with the adoption of more minimally invasive procedures. Transanal TME (taTME) is the latest advanced technique pioneered to tackle difficult pelvic dissections. Areas covered: The evolution of TME surgery from open to laparoscopic, robotic and transanal techniques was explored in this review. The outcomes to date on the latest approach, taTME, are reviewed and the future direction of rectal cancer surgery proposed. A literature search was performed using Embase, Medline, Web of Science and Cochrane databases for articles published between January 2005 to May 2016 using the keywords 'transanal', 'TME', 'laparoscopy', 'robotics', 'minimally invasive', 'outcomes' and 'training'. Expert commentary: Surgical experience in taTME is growing and randomised controlled trials have been planned and initiated worldwide. However, the learning curve for this procedure remains to be established and a structured training programme is necessary to ensure safe introduction and dissemination of the technique in the clinical setting. Further innovation including stereotactic navigation and more specialised transanal equipment are currently being explored and are likely to enhance the technique further.
随着更多微创技术的采用，直肠癌全直肠系膜切除术（TME）的手术方式经历了重大演变。经肛门全直肠系膜切除术（taTME）是为应对困难的盆腔解剖而开创的最新先进技术。涵盖领域：本综述探讨了TME手术从开放手术到腹腔镜、机器人和经肛门技术的演变。对最新方法taTME的迄今结果进行了综述，并提出了直肠癌手术的未来方向。使用Embase、Medline、Web of Science和Cochrane数据库进行文献检索，以查找2005年1月至2016年5月期间发表的文章，关键词为“经肛门”、“TME”、“腹腔镜检查”、“机器人技术”、“微创”、“结果”和“培训”。专家评论：taTME的手术经验正在增加，全球范围内已计划并启动了随机对照试验。然而，该手术的学习曲线仍有待确定，需要一个结构化的培训计划，以确保在临床环境中安全引入和推广该技术。目前正在探索包括立体定向导航和更专业的经肛门设备在内的进一步创新，这可能会进一步改进该技术。
