Five‐year outcome of laparoscopic transanal total mesorectal excision in a single centre—A training model to acquire a new surgical technique

Background Laparoscopic transanal total mesorectal excision (TaTME) has been widely adopted globally. Short‐ and long‐term outcomes vary across different localities, especially during the learning phase. Method and patient The first 100 cases of TaTME performed by two experienced colorectal surgeons between 2015 and 2019 were reviewed. The aim was to analyse the short‐term safety and long‐term oncological outcomes during the implementation of this relatively new technique. Results All cases had biopsy‐confirmed adenocarcinoma of the mid to lower rectum. Sphincter‐preserving TaTME was performed, followed by primary anastomosis and diversion stoma. The mean operation time was 245 ± 54 min. Conversion to open surgery occurred in one case with a history of right hemicolectomy. R0 resection was achieved in all cases, except for one with a close margin of 1 mm. There were six anastomotic leaks, one of which required laparotomy and lavage. The mean hospital stay was 12 ± 9 days. The median follow‐up was 62 months (interquartile range 52–73 months). A total of 25 recurrences were observed: 21 were distant metastases and 4 were local recurrences. The 5‐year disease‐free survival was 72.4%, and the 5‐year overall survival was 82.3%. Conclusion Experience in our centre has shown that TaTME is a safe and reliable technique in terms of both short‐term safety and long‐term oncological outcomes, even during the learning phase. In the absence of formal proctorship during the development of a new technique, hands‐on cadaveric training is essential, and partnership mutual training could be a solution to ensure patient safety and good outcomes in the early phase of the learning curve.