Annals of Coloproctology

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Original Article

Minimally invasive surgery

Minimally invasive transanal excision for rectal tumors: technical feasibility compared to conventional approach: Ji Yeon Mun, Gyu Sung Geong, Nina Yoo, Hyung Jin Kim, Hyeon-Min Cho, Bong-Hyeon Kye; Ann Coloproctol. 2025;41(2):162-168. Published online April 29, 2025; DOI: https://doi.org/10.3393/ac.2024.00864.0123

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Graphical Abstract Abstract PDF Supplementary Material

Purpose
The technique for transanal resection of rectal tumors has evolved from conventional methods to minimally invasive approaches. However, the research comparing long-term results between these approaches is limited.
Methods
Between 2016 and 2022, a total of 133 patients who underwent transanal excision were analyzed. Patients were classified into 2 groups according to surgical approach: conventional transanal approach (CTA) and minimally invasive transanal approach (MTA). Medical records were analyzed to compare surgical and oncological outcomes between the 2 groups.
Results
There were no significant differences observed in patient’s demographics and tumor characteristics, except the MTA group exhibited a statistically longer distance from the anal verge. Although statistical significance was not reached, the MTA group demonstrated a 100% margin-negative rate in contrast to the CTA group, which had worse outcomes for both margin status and fragmentation. Recurrence was observed only in the CTA group containing pT1 rectal cancer and grade 1 neuroendocrine tumor, with negative margins and no fragmentation.
Conclusion
The minimally invasive approach did not demonstrate statistical superiority but showed technical feasibility through the absence of margin-positive cases and the use of the clip handle method. Further studies are needed to validate these findings and assess broader applicability.

Citations

Citations to this article as recorded by

Minimally invasive transanal excision over conventional transanal excision: pursuing the perfect removal of early rectal cancer
HyungJoo Baik
Annals of Coloproctology.2025; 41(2): 105. CrossRef

Review

Colorectal cancer

Dissection layer selection based on an understanding of pelvic fascial anatomy in transanal total mesorectal excision: Daichi Kitaguchi, Masaaki Ito; Ann Coloproctol. 2024;40(4):375-383. Published online August 30, 2024; DOI: https://doi.org/10.3393/ac.2024.00178.0025

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3 Web of Science
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Abstract PDF

This study aimed to review the historical transition of rectal cancer surgery and recent evidence regarding transanal total mesorectal excision (TaTME). Additionally, it outlined the anatomical landmarks and technical considerations essential for successful TaTME. Anatomical studies and surgical techniques were analyzed to identify key landmarks and procedural steps crucial for TaTME. TaTME offers improved visibility and maneuverability even in the deep and narrow pelvis and is expected to contribute to tumor radical cure rates. By securing the circumferential resection margin and distal margin while preserving pelvic autonomic nerve function, TaTME holds promise for maintaining postoperative urinary and sexual functions. Key anatomical landmarks include the endopelvic fascia posteriorly, the S4-pelvic splanchnic nerve laterally, and the prostate or posterior vaginal wall anteriorly. Selecting the appropriate dissection layer based on tumor depth and ensuring precise incision of the tendinous arch of the pelvic fascia contributes to successful TaTME outcomes. TaTME represents a significant advancement in rectal cancer surgery, offering improved outcomes through meticulous attention to anatomical detail and precise dissection techniques. Understanding the historical context of rectal cancer surgery alongside recent evidence on TaTME is essential for optimizing patient outcomes and expanding the safe implementation of this innovative approach.

Citations

Citations to this article as recorded by

Impact of Two‐Team Surgery on Short‐ and Long‐Term Outcomes of Transanal Total Mesorectal Excision for Rectal Cancer
Nobuaki Hoshino, Koya Hida, Yukinari Tokoro, Kazutaka Obama, Takeru Matsuda, Ichiro Takemasa, Tomonori Akagi, Masafumi Inomata, Shigenori Homma, Nobuki Ichikawa, Yoshihiro Kakeji, Seiichiro Yamamoto, Takeshi Naitoh
Annals of Gastroenterological Surgery.2025;[Epub] CrossRef
From the Editor: Uniting expertise, a new era of global collaboration in coloproctology
In Ja Park
Annals of Coloproctology.2024; 40(4): 285. CrossRef
Efficacy of Neoadjuvant Hypofractionated Chemoradiotherapy in Elderly Patients with Locally Advanced Rectal Cancer: A Single-Center Retrospective Analysis
Jae Seung Kim, Jaram Lee, Hyeung-min Park, Soo Young Lee, Chang Hyun Kim, Hyeong Rok Kim
Cancers.2024; 16(24): 4280. CrossRef

Original Article

Colorectal cancer

Recurrence following transanal total mesorectal excision for rectal cancer: a monocentric retrospective series of technically difficult cases: Jonathan Frigault, Geneviève Morin, Sébastien Drolet, Philippe Bouchard, Alexandre Bouchard, Thanh-Quan Philips Ngo, François Letarte; Ann Coloproctol. 2023;39(4):332-341. Published online November 14, 2022; DOI: https://doi.org/10.3393/ac.2022.00178.0025

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Abstract PDF: Purpose
Transanal total mesorectal excision (TaTME) has been proposed to overcome surgical difficulties encountered during rectal resection, especially for patients having high body mass index or low rectal cancer. The aim of this study was to evaluate oncologic outcomes following TaTME.
Methods
This retrospective study included all consecutive patients with rectal cancer who had a TaTME from 2013 to 2019. The main outcome was the incidence of locoregional recurrence by the end of the follow-up period.
Results
Among a total of 81 patients, 96.3% were male, and their mean age was 63±9 years. The mean body mass index was 30.3±5.7 kg/m2, and the median distance from tumor to anal verge was 5.0 cm (interquartile range [IQR], 4.0–6.0 cm). Most patients had a low anterior resection performed (n=80, 98.8%) with a diverting ileostomy (n=64, 79.0%). Distal and circumferential resection margins were positive in 2.5% and 6.2% of patients, respectively. Total mesorectal excision was complete or near complete in 95.1% of patients. A successful resection was achieved in 72 patients (88.9%). After a median follow-up of 27.5 months (IQR, 16.7–48.1 months), 4 patients (4.9%) experienced locoregional recurrence. Anastomotic leaks were observed in 21 patients (25.9%). At the end of the follow-up, 69 patients (85.2%) were stoma-free.
Conclusion
TaTME was associated with acceptable oncological outcomes, including low locoregional recurrence rates in selected patients with low rectal cancer. Although associated with a high incidence of postoperative morbidities, the use of TaTME enabled a high rate of successful sphincter-saving procedures in selected patients who posed a technical challenge.

Review

Malignant disease,Rectal cancer,Surgical technique

Transanal total mesorectal excision for rectal cancer: it’s come a long way and here to stay: Jing Yu Ng, Chien-Chih Chen; Ann Coloproctol. 2022;38(4):283-289. Published online August 29, 2022; DOI: https://doi.org/10.3393/ac.2022.00374.0053

7,369 View
170 Download
15 Web of Science
16 Citations

Abstract PDF

Transanal total mesorectal excision (TaTME) was introduced as a novel technique to deal with rectal cancers. Its transanal approach offered the shortest distance to approach a challenging location, allowing an excellent visualization of the distal resection margin. Since its introduction in 2010, a significant amount of research has been put in to measure its development. In this review, we look at its ancestry, the genesis for its introduction and continued evolution as well as some of the important outcomes in its journey thus far. The importance of a structured and proctored learning journey is also stressed to enable the safe application and development of this technique. Beyond this, the TaTME movement has progressed relentlessly and its utility has been expanded to the management of benign conditions such as inflammatory bowel disease, Hartman reversals, and anastomotic strictures. We believe that the continued development and adoption of TaTME worldwide is here to stay.

Citations

Citations to this article as recorded by

Rectal Eversion as an Anus-sparing Technique in Laparoscopic Low Anterior Resection With Double Stapling Anastomosis: Long-term Functional Results
Servet Karagul, Serdar Senol, Oktay Karakose, Huseyin Eken, Cuneyt Kayaalp
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2025;[Epub] CrossRef
Histopathological outcomes of transanal, robotic, open, and laparoscopic surgery for rectal cancer resection. A Bayesian network meta-analysis of randomized controlled trials
Nicola de’Angelis, Carlo Alberto Schena, Danila Azzolina, Maria Clotilde Carra, Jim Khan, Caroline Gronnier, Sébastien Gaujoux, Paolo Pietro Bianchi, Antonino Spinelli, Philippe Rouanet, Aleix Martínez-Pérez, Patrick Pessaux
European Journal of Surgical Oncology.2025; 51(1): 109481. CrossRef
Brief insight regarding the use of transanal, laparoscopic, and robotic total mesorectal excision for rectal cancer
Kevan English
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
Oncological and Functional Outcomes After Minimally Invasive Surgery for Mid and Low Rectal Adenocarcinoma: A Review
Antonio Costanzo, Lorenzo Vescovi, Valentina Rampulla, Michela Caprioli, Michele Marini, Andrea Rigamonti, Daniele Passannanti, Valentina Crisafulli, Antonio Floridi
Cureus.2025;[Epub] CrossRef
Laparoscopic total mesorectal excision versus transanal total mesorectal excision for mid and low rectal cancer: A systematic review and meta-analysis
Zhang Yi Chi, Ou Gang, Feng Xiao Li, Lu Ya, Zhou Zhijun, Du Yong Gang, Ran Dan, Liu Xin, Liu Yang, Zhang Peng, Luo Yi, Lin Dong, Zhang De Chun
Medicine.2024; 103(4): e36859. CrossRef
Sex Disparities in Rectal Cancer Surgery: An In-Depth Analysis of Surgical Approaches and Outcomes
Chungyeop Lee, In Ja Park
The World Journal of Men's Health.2024; 42(2): 304. CrossRef
Quality of life and functional outcomes after laparoscopic total mesorectal excision (LaTME) and transanal total mesorectal excision (taTME) for rectal cancer. an updated meta-analysis
Sara Lauricella, Francesco Brucchi, Francesco Maria Carrano, Diletta Cassini, Roberto Cirocchi, Patricia Sylla
International Journal of Colorectal Disease.2024;[Epub] CrossRef
Learning Curve for Robotic Colorectal Surgery
Neng Wei Wong, Nan Zun Teo, James Chi-Yong Ngu
Cancers.2024; 16(19): 3420. CrossRef
Beyond survival: a comprehensive review of quality of life in rectal cancer patients
Won Beom Jung
Annals of Coloproctology.2024; 40(6): 527. CrossRef
Case report on a rare complication after transanal total mesorectal excision (TaTME) for rectal malignancy vesicorectal fistula
Sapphire Melody Ho, Kishore Rajaguru, Jing Yu Ng, Choon Sheong Seow
International Journal of Surgery Case Reports.2023; 105: 108009. CrossRef
Do Laparoscopic Approaches Ensure Oncological Safety and Prognosis for Serosa-Exposed Colon Cancer? A Comparative Study against the Open Approach
Ji-Hyun Seo, In-Ja Park
Cancers.2023; 15(21): 5211. CrossRef
Unveiling the profound advantages of total neoadjuvant therapy in rectal cancer: a trailblazing exploration
Kyung Uk Jung, Hyung Ook Kim, Hungdai Kim, Donghyoun Lee, Chinock Cheong
Annals of Surgical Treatment and Research.2023; 105(6): 341. CrossRef
Surgical Techniques for Transanal Local Excision for Early Rectal Cancer
Gyoung Tae Noh
The Ewha Medical Journal.2023;[Epub] CrossRef
Influence of the COVID-19 Pandemic on the Treatment Patterns and Outcomes of Colorectal Cancer
In Ja Park
The Ewha Medical Journal.2023;[Epub] CrossRef
Preventing Anastomotic Leakage, a Devastating Complication of Colorectal Surgery
Hyun Gu Lee
The Ewha Medical Journal.2023;[Epub] CrossRef
How Can We Improve the Tumor Response to Preoperative Chemoradiotherapy for Locally Advanced Rectal Cancer?
Jeonghee Han
The Ewha Medical Journal.2023;[Epub] CrossRef

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