For people with rectal cancer, surgery is often the main treatment. But the standard minimally invasive approach, laparoscopic surgery, can be difficult, especially for tumors low in the rectum. Sometimes surgeons have to convert to a larger open incision, which means a longer recovery and more pain. Now, a large international trial shows that a newer technique called transanal total mesorectal excision (TaTME) may offer a better option.
Researchers randomly assigned 1,103 patients with mid or low rectal cancer to receive either TaTME or standard laparoscopic surgery. The patients were treated at 28 hospitals around the world. The goal was to see if TaTME was as good as or better than the standard approach, especially in terms of how often surgeons had to convert to open surgery.
The results were striking. Only 1% of patients who had TaTME needed conversion to open surgery, compared with 17% of those who had standard laparoscopic surgery. That is a huge difference. In plain terms, for every 100 people treated with TaTME, about 1 would need a switch to open surgery, versus 17 out of 100 with the standard method. The odds of conversion were 97% lower with TaTME.
Importantly, the two techniques had similar rates of complications within 90 days after surgery. About 20% of TaTME patients and 18% of laparoscopic patients had some complication, such as infection or bleeding. Major complications were also similar: 11% for TaTME versus 9% for laparoscopy. Anastomotic leakage, a serious problem where the reconnected bowel leaks, occurred in 10% of TaTME patients and 8% of laparoscopic patients. These differences were not statistically significant, meaning they could be due to chance.
The quality of the removed tissue was also comparable. Surgeons were able to remove the tumor completely in 84% of TaTME cases and 86% of laparoscopic cases. Positive margins, where cancer cells are left behind, were rare in both groups.
However, this study only reports short-term results. The long-term cancer outcomes, such as whether the cancer comes back (local recurrence) and how long patients live, are not yet known. The researchers are still following the patients to get that information. So while TaTME appears safe and effective in the short term, we do not yet know if it is as good as standard surgery for preventing cancer from returning.
For patients facing rectal cancer surgery, this study offers hope that a newer technique might make the operation less invasive and reduce the chance of needing a big incision. But it is important to remember that this is just one study, and long-term data are needed. Patients should discuss the options with their surgeon, including the risks and benefits of each approach, to make the best decision for their individual situation.
