1. Short-term Outcomes of Transanal Total Mesorectal Excision
for Rectal Cancer: Experience of CMUH
廖庭儀
柯道維 蔡元耀 黃郁純 陳奕彰 張伸吉
江驊哲 陳宏彰 廖師賢 王輝明 陳自諒
中國醫藥大學附設醫院
大腸直腸肛門外科

2. Introduction
Whether open or laparoscopic, TME is a difficult surgery.

3. Introduction
Whether open or laparoscopic, TME is a difficult surgery.

4. Introduction
Some consider perform TME from buttom to up.

5. safety and feasibility
Aim
safety and feasibility
short-term outcomes

6. Material & Method n=51 Middle or low rectal cancer
Jan – Jan. 2018
CMU Hospital

7. Patient Characteristics
Data
Age, y, mean±SD
63.0±11.4
Male, n(%)
33 (64.71%)
BMI, kg/m2, mean±SD
24.3±3.4
ASA score, n(%) II
31 (60.78%)
III
20 (39.22%)
Neoadjuvant CCRT, n(%)
34 (66.67%)
Tumor location
Middle rectum, n(%)
26 (50.98%)
Low rectum, n(%)
25 (49.02%)
By NCCN guideline, T3以上或any N, 做nCCRT

8. Preoperative TNM stage
Data
Stage, n(%)
1 (1.96%) I
9 (17.65%) II
5 (9.80%)
III
26 (50.98%) IV
6 (11.76%)
N/A
4 (7.84%)

9. Perioperative Outcomes
Data
Operation time, mins, mean±SD
324.0±104.6
Blood loss, ml, mean±SD
98.0±126.4
Conversion, n(%)
0 (0%)
Protective stoma, n(%)
51 (100%)
Anastomosis method
Hand-sewn, n(%)
28 (54.90%)
Staple, n(%)
23 (45.10%)
Anastomosis site, cm FAV, mean±SD
2.6±1.0

10. Operation time, minutes
Analysis
Operation time, minutes
Mean: 324.0

11. Perioperative Outcomes
Data
Intraoperative complications, n(%)
3 (1.96%)
Left internal iliac artery injury
1 (1.96%)
Rectal and vaginal perforation
Urethral injury

12. Histopathological Characteristics
Data
Tumor size, cm, mean±SD
2.2±1.4
Distal margin, cm, mean±SD
1.8±1.3
Circumferential margin, mm, mean±SD
11.0±9.1
Circumferential resection margin(CRM)
positive, n(%)
7 (13.73%)
negative, n(%)
41 (80.39%)
Total LN numbers, mean±SD
14.9±7.0
aim

13. Pathological Stage Data With nCCRT n=34 Complete response 8 (23.53%) I
4 (11.76%) II
III
10 (29.41%) IV
aim

14. Pathological Stage Data Without nCCRT n=17 1 (5.88%) I 6 (35.29%) II
1 (5.88%) I
6 (35.29%) II
2 (11.76%)
III
4 (23.53%) IV
N/A
3 (17.65%)
aim

15. Postoperative Outcomes
Data
Hospital stay, days, mean±SD
6.6±2.7
Removal of Foley, POD, mean±SD
2.1±2.2
Re-catheterization, n(%)
9 (17.65%)
Prolonged removal of Foley , n(%)
4 (7.84%)
Anastomosis leakage, n(%)
8 (15.69%)
Other complications
Ileus, n(%)
1 (1.96%)
UTI, n(%)
2 (3.92%)
Recto-vaginal fistula, n(%)

16. Analysis
Anastomotic leakage

17. Conclusion
TaTME is an alternative approach for middle and low rectal cancer.
It is feasible and safe.
Complications, ex: urethral injury…
TaTME is safe and feasible
TaTME is not an easy procedure. Need experienced surgeon to perform.
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