Department of Surgery, Cantonal Hospital Winterthur, Brauerstrasse 15, Postfach 834, 8401, Winterthur, Switzerland.
University of Basel, Basel, Switzerland.
Surg Endosc. 2018 Mar;32(3):1091-1103. doi: 10.1007/s00464-017-5990-2. Epub 2017 Dec 12.
The management of rectal cancer has evolved over the years, including the recent rise of Transanal Total Mesorectal Excision (TaTME). TaTME addresses the limitations created by the bony confines of the pelvis, bulky tumours, and fatty mesorectum, particularly for low rectal cancers. However, guidance is required to ensure safe implementation and to avoid the pitfalls and potential major morbidity encountered by the early adopters of TaTME. We report a broad international consensus statement, which provides a basis for optimal clinical practice.
Forty international experts were invited to participate based on clinical and academic achievements. The consensus statements were developed using Delphi methodology incorporating three successive rounds. Consensus was defined as agreement by 80% or more of the experts.
A total of 37 colorectal surgeons from 20 countries and 5 continents (Europe, Asia, North and South America, Australasia) contributed to the consensus. Participation to the iterative Delphi rounds was 100%. An expert radiologist, pathologist, and medical oncologist provided recommendations to maximize relevance to current practice. Consensus was obtained on all seven different chapters: patient selection and surgical indication, perioperative management, patient positioning and operating room set up, surgical technique, devices and instruments, pelvic anatomy, TaTME training, and outcomes analysis.
This multidisciplinary consensus statement achieved more than 80% approval and can thus be graded as strong recommendation, yet acknowledging the current lack of high level evidence. It provides the best possible guidance for safe implementation and practice of Transanal Total Mesorectal Excision.
近年来，直肠癌的治疗方法不断发展，包括最近采用的经肛门全直肠系膜切除术（TaTME）。TaTME 解决了骨盆骨限制、大肿瘤和脂肪性直肠系膜带来的局限性，尤其适用于低位直肠癌。然而，需要有指导意见来确保安全实施，并避免早期采用 TaTME 的医生所遇到的陷阱和潜在的严重发病率。我们报告了一项广泛的国际共识声明，为最佳临床实践提供了基础。
根据临床和学术成就，邀请了 40 名国际专家参与。共识声明是使用德尔菲法制定的，包括三个连续轮次。共识定义为 80%或以上的专家达成一致。
来自 20 个国家和 5 个大洲（欧洲、亚洲、北美和南美、澳大拉西亚）的 37 名结直肠外科医生参与了共识。对迭代德尔菲轮次的参与率为 100%。一位专家放射科医生、病理学家和肿瘤内科医生提供了建议，以最大限度地提高与当前实践的相关性。在所有七个不同章节都达成了共识：患者选择和手术适应证、围手术期管理、患者体位和手术室设置、手术技术、器械和仪器、盆腔解剖、TaTME 培训和结果分析。
这项多学科共识声明获得了超过 80%的认可，因此可以评为强烈推荐，但也承认目前缺乏高级别的证据。它为安全实施和实践经肛门全直肠系膜切除术提供了最佳指导。
