Transanal total mesorectal excision for rectal cancer

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 19 sources, which was discussed by the committee. The evidence included 4 systematic reviews, 2 registry reports, 3 non-randomised comparative studies (1 of which was also included in a systematic review), 4 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.

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.

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.

Patient commentary was sought but none was received.

The committee noted that this is a highly challenging procedure so extensive training and mentorship is needed for it to be done safely.

The committee noted that the Association of Coloproctology of Great Britain and Ireland has published recommendations on this procedure.