Transanal total mesorectal excision for rectal cancer
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3 Committee considerations
The evidence
3.1 NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 15 sources, which was discussed by the committee. The evidence included 2 systematic reviews, 2 registry reports, 2 non-randomised comparative studies (1 of which was also included in a systematic review), 3 cohort studies, 3 randomised controlled trials, 1 case series and 2 case reports. It is presented in the summary of key evidence section in the interventional procedures overview. Other relevant literature is in the appendix of the overview.
3.2 The professional experts and the committee considered the key efficacy outcomes to be: disease-free survival, functional outcome scores, quality of life and preservation of sexual function.
3.3 The professional experts and the committee considered the key safety outcomes to be: local or regional recurrence including malignancy dissemination, urethral injury, carbon dioxide embolus, anastomotic leak and rectal prolapse.
Committee comments
3.4 The committee noted that this is a highly challenging procedure that needs extensive training and mentorship to be done safely.
Tom Clutton-Brock
Chair, interventional procedures advisory committee
July 2021
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