Total Mesorectal Excision (TME), as first described by Heald in 1982, is accepted in the UK as the standard surgical treatment for mid and lower third rectal cancers. Transanal TME (TaTME) is a relatively new technique whereby the rectum is mobilised transanally in a retrograde fashion. This may be combined with multiple or single port laparoscopy - hybrid TaTME.
ACPGBI is aware of a significant groundswell of interest in this approach and in view of the paucity of randomised evidence attesting to its efficacy is keen to ensure that adequate governance arrangements are in place. This will ensure that progress can be made without patient detriment.
It is the ACPGBI position that all colorectal surgeons performing TaTME need to demonstrate appropriate training in the procedure. It would seem likely that local experience could be maximised with 2-consultant operating. Patients should be made aware that this is a new procedure. Surgeons should contribute their data to the national TaTME registry. Consideration should also been given to the publication of case-controlled studies or a randomised controlled trial.
We understand that these points are intuitive to the vast majority of colorectal surgeons, however we felt that ACPGBI needed a position on this specific procedure.
Chair of the Multidisciplinary Clinical Committee
ACPGBI President 2015-2016