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J.Jpn. Surg. Soc.. 122(4): 392-397, 2021

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Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan

Atsushi Hamabe, Ichiro Takemasa

Transanal total mesorectal excision (TaTME) emerged as an evolutionary approach in the surgical treatment of rectal cancer. It can be applied in procedures in the deep pelvis where precise dissection would be difficult if carried out transabdominally, thereby potentially improving the quality of TME. Accumulating evidence has made it clearer how anatomical structures can be seen from the anal approach, allowing the introduction of TaTME into clinical practice under appropriate circumstances. In contrast, rapid advances in robotic surgery for rectal cancer have also changed the trend in adopting treatment options. Although the rectum can be mobilized to the level of the anal canal more easily in robotic surgery compared to conventional laparoscopic surgery, there are still extremely difficult cases that cannot be treated transabdominally alone. In such selective cases, TaTME continues to be a valuable tool to achieve the most important concept in rectal cancer resection, which is “completion of TME with a circumferential resection margin of more than 1 mm.” In the future, the indications for TaTME are likely to be for more selective, difficult cases, and therefore the establishment of surgeon education in TaTME will gain more importance.

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