{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T07:50:09Z","timestamp":1777017009792,"version":"3.51.4"},"reference-count":29,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2018,5,14]],"date-time":"2018-05-14T00:00:00Z","timestamp":1526256000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>To compare the learning curve for trans\u2010anal total mesorectal excision (<jats:styled-content style=\"fixed-case\">TATME<\/jats:styled-content>) with laparoscopic <jats:styled-content style=\"fixed-case\">TME<\/jats:styled-content> started by a perineal approach (<jats:styled-content style=\"fixed-case\">LTME<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>The first 34 consecutive patients who underwent <jats:styled-content style=\"fixed-case\">TATME<\/jats:styled-content> for low rectal cancer were matched with <jats:styled-content style=\"fixed-case\">LTME<\/jats:styled-content> (performed by the same surgeon) for gender, body mass index and chemoradiation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty\u2010four patients undergoing <jats:styled-content style=\"fixed-case\">TATME<\/jats:styled-content> (23 men; 58\u00a0\u00b1\u00a014\u00a0years) were matched with 34 undergoing <jats:styled-content style=\"fixed-case\">LTME<\/jats:styled-content> (23 men; 59\u00a0\u00b1\u00a013\u00a0years). Intra\u2010operative complications occurred more frequently during <jats:styled-content style=\"fixed-case\">TATME<\/jats:styled-content> (21%) than <jats:styled-content style=\"fixed-case\">LTME<\/jats:styled-content> (6%), but this difference was not significant (<jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.07). The complications of <jats:styled-content style=\"fixed-case\">TATME<\/jats:styled-content> included rectal (<jats:italic>n\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>4), bladder (<jats:italic>n\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>1) and vaginal (<jats:italic>n\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>1) injury and bleeding (<jats:italic>n\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>1). Length of stay and postoperative overall and major morbidities were similar between groups. Early symptomatic anastomotic leakage (<jats:styled-content style=\"fixed-case\">AL<\/jats:styled-content>) occurred in 1\/34 <jats:styled-content style=\"fixed-case\">TATME<\/jats:styled-content> and 5\/34 <jats:styled-content style=\"fixed-case\">LTME<\/jats:styled-content> (15%; <jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.02) procedures. Asymptomatic <jats:styled-content style=\"fixed-case\">AL<\/jats:styled-content> occurred in four <jats:styled-content style=\"fixed-case\">TATME<\/jats:styled-content> (12%) and four <jats:styled-content style=\"fixed-case\">LTME<\/jats:styled-content> (12%, <jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>1). Thus, the overall rate of <jats:styled-content style=\"fixed-case\">AL<\/jats:styled-content> was 5\/34 (15%) for <jats:styled-content style=\"fixed-case\">TATME <\/jats:styled-content><jats:italic>vs<\/jats:italic> 9\/34 (26%) for <jats:styled-content style=\"fixed-case\">LTME<\/jats:styled-content> (<jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.4). No significant difference between the two groups was noted with regard to tumour, number of harvested and positive lymph nodes, R1 resection rate or completeness of the mesorectum. Metastatic recurrence was similar between groups (15% <jats:italic>vs<\/jats:italic> 18%, <jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.7), but follow\u2010up was shorter after <jats:styled-content style=\"fixed-case\">TATME<\/jats:styled-content> (13\u00a0\u00b1\u00a06\u00a0months) than after <jats:styled-content style=\"fixed-case\">LTME<\/jats:styled-content> (25\u00a0\u00b1\u00a014\u00a0months; <jats:italic>P\u00a0<\/jats:italic>&lt;<jats:italic>\u00a0<\/jats:italic>0.0001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The <jats:styled-content style=\"fixed-case\">TATME<\/jats:styled-content> learning curve seems to be associated with a significant rate of intra\u2010operative complications. Because no significant benefit has been reported to date, more evidence is needed before <jats:styled-content style=\"fixed-case\">TATME<\/jats:styled-content> can be considered as a better approach than laparoscopic <jats:styled-content style=\"fixed-case\">TME<\/jats:styled-content> with a perineal approach first in patients with low rectal cancer.<\/jats:p><\/jats:sec>","DOI":"10.1111\/codi.14238","type":"journal-article","created":{"date-parts":[[2018,4,25]],"date-time":"2018-04-25T08:03:19Z","timestamp":1524643399000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":45,"title":["Is trans\u2010anal total mesorectal excision really safe and better than laparoscopic total mesorectal excision with a perineal approach first in patients with low rectal cancer? A learning curve with case\u2010matched study in 68 patients"],"prefix":"10.1111","volume":"20","author":[{"given":"D.","family":"Mege","sequence":"first","affiliation":[{"name":"Department of Colorectal Surgery Beaujon Hospital Assistance Publique\u2010H\u00f4pitaux de Paris Universit\u00e9 Paris VII Clichy France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E.","family":"Hain","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery Beaujon Hospital Assistance Publique\u2010H\u00f4pitaux de Paris Universit\u00e9 Paris VII Clichy France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Z.","family":"Lakkis","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery Beaujon Hospital Assistance Publique\u2010H\u00f4pitaux de Paris Universit\u00e9 Paris VII Clichy 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