Evaluation of transanal total mesorectal excision in treatment of low rectal cancer

Introduction Colorectal cancer is the third most prevalent cancer in the world and the fourth leading cause of cancer-related death. Treatment results are directly related to the quality of surgery. Complete total mesorectal excision is challenging, especially in obese male patients with narrow or deep pelvis. The transanal approach helps to overcome exposure limitation and instrumentation in low pelvic surgery, yielding a better treatment outcome. Objectives To assess the transanal approach for total mesorectal excision in the treatment of rectal cancer regarding operative time, intraoperative events, and oncological safety. Patients and methods A total of 17 patients with mid to low rectal cancer, attending the colorectal unit of General Surgery Department of Ain Shams University Hospital, were included in the study. All patients underwent laparoscopic anterior resection with transanal total mesorectal excision. Results A total of 12 male and five female patients were included in this study. The mean operative time was 311.82 +/- 44.98 min. Transanal total mesorectal excision was completed in 14 patients. Laparoscopic conversion was required in three patients. Postoperative histopathological assessment of the resected specimens showed that adequate oncological resection was accomplished in all of our patients. Conclusion Transanal total mesorectal excision is a feasible and reproducible technique for the surgical management of low rectal cancer. It is safe after gaining appropriate experience. It carries an extra advantage for male patients with narrow or deep pelvis and those with tough edematous pelvic planes after chemoradiation.