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Phase II Clinical Trial to Evaluate the Efficacy of Transanal Endoscopic Total Mesorectal Excision for Rectal Cancer

Park, Sung, Chan, M.D.1; Sohn, Dae, Kyung, M.D.1; Kim, Min, Jung, M.D.1; Chang, Hee, Jin, M.D.1; Han, Kyung, Su, M.D.1; Hyun, Jong, Hee, M.D.1; Joo, Jungnam, Ph.D.2; Oh, Jae, Hwan, M.D.1

Diseases of the Colon & Rectum: May 2018 - Volume 61 - Issue 5 - p 554–560
doi: 10.1097/DCR.0000000000001058
Original Contributions: Colorectal Cancer
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BACKGROUND: Total mesorectal excision has become the standard treatment for rectal cancer, and several investigators have shown that a transanal approach is a feasible option.

OBJECTIVE: This study aimed to evaluate the efficacy of transanal endoscopic total mesorectal excision in patients with rectal cancer.

DESIGN: This study was a prospective, single-arm phase II trial. It was registered on under identifier NCT02406118.

SETTINGS: Inpatients at a hospital specializing in oncology were selected.

PATIENTS: This prospective study enrolled 49 patients with rectal cancer located 3 to 12 cm from the anal verge who were scheduled to undergo radical surgery.

INTERVENTIONS: Laparoscopy-assisted transanal total mesorectal excision was performed.

MAIN OUTCOME MEASURES: The primary end point was total mesorectal excision quality and circumferential resection margin. Secondary end points included the number of harvested lymph nodes, operation time, and 30-day postoperative complications.

RESULTS: From March 2015 to April 2016, 32 men and 17 women with rectal cancer were enrolled. The mean age was 61.2 years, and mean BMI was 23.3 kg/m2. The mean operating time was 158 minutes, and the mean estimated blood loss was 89.3 mL. There were no intraoperative complications and no conversions to open surgery. Successful treatment based on total mesorectal excision quality and circumferential resection margin was achieved in 45 patients (91.8%). Fifteen patients (30.6%) had 30-day postoperative complications, including 7 (14.3%) with anastomotic dehiscence, 5 (10.2%) with urinary retention, 2 (4.1%) with abdominal wound complications, and 1 (2.0%) with ileus. There was no postoperative mortality.

LIMITATIONS: This was a noncomparative single-arm trial conducted at a single institution.

CONCLUSIONS: Transanal endoscopic total mesorectal excision showed acceptable results based on perioperative and short-term oncologic outcomes. Further investigations are necessary to show the benefits and long-term outcomes of this procedure. See Video Abstract at

1 Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea

2 Biometrics Research Branch, Research Institute and Hospital, National Cancer Center, Goyang, Korea

Funding/Support: This work was supported by a National Cancer Center Grant (NCC-1510150).

Financial Disclosures: None reported.

Sung Chan Park and Dae Kyung Sohn contributed equally to this article.

Correspondence: Jae Hwan Oh, MD, Center for Colorectal Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Republic of Korea. E-mail:

© 2018 The American Society of Colon and Rectal Surgeons