Background: Total mesorectal excision (TME) is the standard surgical principle in the treatment of rectal cancer. However, in recent years, there has been an increasing debate about how to obtain better results in circumferential margin (CRM) and distal margins of the surgical specimen. The CRM and distal margin involvement rates have been linked to local recurrence and disease-free survival rates. In this study, we compared three surgical techniques for the treatment of lower rectal cancer. Methods: From July 2008 to April 2018, we identified consecutive patients with lower rectal cancer who underwent TME. According to the surgical technique, we divided the patients into three groups: transanal TME (TaTME), laparoscopic TME (LaTME), and open TME (OpTME). Results: A total of 126 patients underwent TME; 39, 64 and 23 patients underwent TaTME, LaTME, and OpTME respectively. Tumor location was lower in the TaTME group than the other groups (p < 0.01). TaTME resulted in longer operation time than the other two groups (p < 0.01). In pathological outcomes, no patients with a CRM <1 mm were observed in the TaTME group compared with five (7.8%) and three patients (13.0%) with CRM <1 mm in the LaTME and OpTME group respectively (p = 0.035). Patients in the TaTME and LaTME groups also had a better disease-free survival than OpTME group (p < 0.01). Conclusion: TaTME provides surgeons with a novel and effective method to treat lower rectal cancer. In the short-term outcomes, TaTME achieved better pathological results and disease free survival than OpTME but not significantly superior to LaTME. Further studies are necessary to evaluate the long-term oncological results.
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