Emile Sameh Hany, de Lacy F Borja, Keller Deborah Susan, Martin-Perez Beatriz, Alrawi Sadir, Lacy Antonio M, Chand Manish
Department of General Surgery, Mansoura Faculty of Medicine, Mansoura City 35516, Egypt.
Department of Surgery, Hospital Clinic, University of Barcelona, Barcelona 08036, Spain.
World J Gastrointest Surg. 2018 Mar 27;10(3):28-39. doi: 10.4240/wjgs.v10.i3.28.
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.
局部晚期直肠癌根治性治疗的金标准是行全直肠系膜切除术（TME）根治性切除。无论采用何种手术平台，TME都是降低局部复发率和改善生存结局的最有效治疗策略。然而，TME存在相关的并发症、功能后果以及生活质量（QoL）问题；在现代直肠癌多学科治疗过程中必须考虑这些风险。这促使了新手术技术的发展，以改善患者、肿瘤学及QoL结局。在这项工作中，我们回顾了从TME到经肛门全直肠系膜切除术（TaTME）通过更传统的微创平台的演变。回顾了该手术的发展、安全性和可行性、预期的益处和风险、实施及教育模式，以及TaTME在结直肠手术中的研究和实施的未来方向。虽然已有令人满意的短期结果报道，但该手术尚处于起步阶段，来自对照试验的长期结局和确切结果仍未可知。随着安全性和可行性证据的积累，标准化教学、培训和安全推广的结构化培训项目将有助于TaTME的安全推广。
