• Antonio M Lacy, Marta M Tasende, Salvadora Delgado, María Fernandez-Hevia, Marta Jimenez, Borja De Lacy, Antoni Castells, Raquel Bravo, Steven D Wexner, and Richard J Heald.
• Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases (ICMDM), Hospital Clinic, IDIBAPS, Biomedical Research Center (CIBERehd), Esther Koplowitz Center, University of Barcelona, Barcelona, Spain. Electronic address: alacy@clinic.ub.es.
• J. Am. Coll. Surg. 2015 Aug 1; 221 (2): 415-23.

BackgroundThe anatomic difficulties that we have to deal with in open surgery for rectal cancer have not been overcome with the laparoscopic approach. In the search for a solution, a change of concept arose: approaching the rectum from below. The main objectives of this study were to show the potential advantages of the hybrid transabdominal-transanal total mesorectal excision (taTME). This approach may improve quality of the mesorectal specimens. Second, proctectomy can be technically easier and more safely performed "down to up," which would result in shorter surgical times, lower conversion rates, and less morbidity.Study DesignA prospective series of hybrid taTME was conducted from October 2011 to November 2014.ResultsDuring the study period, 140 procedures were performed. Mean operative time was 166 minutes. There were no conversions or intraoperative complications. Macroscopic quality assessment of the resected specimen was complete in 97.1% and nearly complete in 2.1%. Thirty-day morbidity was minor (Clavien-Dindo I + II) in 24.2% and major (Clavien-Dindo III + IV) in 10 %. No patient died within the first 30 days postsurgery (Clavien-Dindo V). The mean follow-up was 15 months, with a 2.3% local recurrence rate and a 7.6% rate of systemic recurrence.ConclusionsPathologic analysis showed a very good macroscopic quality of TME specimens, which is the most important prognostic factor in rectal cancer. Intraoperative outcomes regarding conversion, surgical times, and intraoperative complications are very satisfactory. Short-term morbidity and oncologic outcomes are as good as in other laparoscopic TME series.Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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