- Transanal total mesorectal excision (TaTME) compensates for the lack of vision of the most distal part of the rectum, a difficulty common in other techniques like laparotomy, laparoscopy or robot-assisted surgery
- Improvement of vision in this area reduces the chances of some patients with rectal tumors located very close to the anus requiring permanent colostomy, although a temporary ileostomy will be necessary for a few months
- In some non-obese patients whose tumors are not particularly large, this technique allows the tumor to be removed through the anus itself, so it would not be necessary to make an incision in the abdomen
- The technique, which is less than ten years old, is currently practiced in just a few hospitals in the country, among which is MD Anderson Cancer Center Madrid
Total mesorectal excision, that is, the removal of the rectum and surrounding fat and lymph nodes, is the standard treatment for rectal cancer - an effective approach that can be performed by laparotomy (open surgery), laparoscopy or robot-assisted surgery. The problem with this approach is "the lack of clear vision of the most distal part of the rectum, which makes complete resection of the tumor difficult", explains Dr. Oscar Alonso, a specialist in gastrointestinal surgical oncology at MD Anderson Madrid. Therefore, the closer the tumor is to the anus, the more difficult it is to see and more likely the resection is to be incomplete and with tumor recurrence.
Now, transanal total mesorectal excision (TaTME) aims to solve that vision problem. Carried out in combination with the traditional mesorectal excision by laparotomy, laparoscopy or robot-assisted techniques, TaTME compensates for the lack of vision of the most distal part of the rectum and, therefore, allows more patients with localized rectal cancer very close to the anus (those who usually require permanent colostomy) to opt for temporary ileostomy.
"As we approach the anus, the pelvis narrows, in the shape of an 'L' and it is difficult to see the last part of the ‘L’”, says Dr. Alonso. So, instead of entering from above, with TaTME we enter from below, from the anus, using laparoscopic instruments. "Through the anus, we move towards the rectum, where we make a circumferential incision to then have access to the pelvis and perform the total mesorectal excision," explains the specialist. During the procedure, there may be two teams of professionals, each of which is in charge of resecting one of the parts of the 'L', or a single team, which would start with the longest part of the 'L' to then continue with the shorter part.
In non-obese patients with small tumors, this technique even allows the tumor to be extracted through the anus, so that "it would not be necessary to extract the tumor through the abdomen, an approach normally requiring an incision of 5-7 centimeters above of the pubis ", points out Dr. Alonso.
In addition, while it is true that many patients with rectal cancer can also avoid permanent colostomy with laparoscopic or laparotomic surgery, Dr. Alonso again mentions the particular difficulty in patients with rectal cancer located very close to the anus. It is precisely in these patients with rectal cancer in the middle third and lower third of the colon for whom this novel technique is indicated, which is currently only practiced in some specialized hospitals in Spain, among which is MD Anderson Madrid.
Finally, Dr. Alonso emphasizes the improvement in the quality of life of these patients, who achieve a more complete resection with a less invasive procedure. "Patient recovery is more rapid and as a result, their quality of life is also improved," he says.