• Managing rectal cancer in an ageing population with reduced functional reserve and complex co-morbidities remains under-researched and challenging. • The choice of surgical procedure must be tailored to each patient, taking all factors into account and involving shared decision-making between the surgeon and the patient. • TaTME improves surgical outcomes: conversion rate and blood loss are significantly lower in the TaTME group with comparable operative time. • Compared with conventional laparoscopy, TaTME reduces severe morbidity and hospital stay. • TaTME is oncologically safe as both pathologic and short-term oncologic outcomes are comparable to those achieved through laparoscopy. Low Hartmann's (LH) procedure for rectal cancer is indicated for frail patients with a high risk of anastomotic fistulas or poor functional outcomes. While transanal total mesorectal excision (TaTME) offers potential technical advantages over transabdominal laparoscopy, its clinical benefits are lacking. We aimed to evaluate whether TaTME improves short-term outcomes of the LH procedure compared with transabdominal laparoscopy. We retrospectively evaluated all patients who underwent laparoscopic LH procedures for mid or low rectal cancer at our center from 2010 to 2023. The primary endpoint was 90-day morbidity. The secondary endpoints included conversion rate, pelvic abscess rate, length of hospital stay (LHS), and oncological quality of resection. The baseline characteristics of the patients were comparable between the laparoscopic (Lap; n = 44) and TaTME ( n = 31) groups. Severe morbidity was significantly lower in the TaTME group (3.2% vs. 23%; P = 0.04), with a lower pelvic abscess rate (9.6% vs. 25%, P = 0.04). Operative time was comparable, but conversion rate and blood loss were significantly lower in the TaTME group. LHS was shorter in the TaTME group (12.3 vs. 16.9 days; P = 0.03), with a comparable readmission rate. Pathologic outcomes, including resection margins and mesorectal quality, were comparable between the groups. Among patients with 3-year follow-up data, local recurrence occurred in 3 (7.6%) and 2 (7.7%) patients in the Lap and TaTME groups, respectively ( P = 1). The TaTME approach for the LH procedure can be a valuable option for rectal cancer management, as it reduces severe morbidity and hospital stay, without compromising oncologic outcomes.
Saadoun et al. (Sun,) studied this question.