الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Background: Laparoscopic total mesorectal excision (LapTME) faced many obstacles in obese male with narrow pelvis and bulky mesorectum with increased risk of incomplete mesorectal excision and positive circumferential (CRM) and distal resection margins (DRM). Transanal total mesorectal excision (TaTME) is reported to result in a better quality TME specimen, lower incidence of CRM and DRM involvement and higher rates of sphincter preservation. To date, there is still a debate about the feasibility and efficacy of transanal versus the laparoscopic approach for total mesorectal excision in middle and low rectal cancer. Aim of the work: This study was designed to compare the surgical, oncological and functional outcome of the trans-anal versus the laparoscopic TME in the management of rectal cancer cases. Patients and Methods: This is a prospective comparative study where 38 patients of middle or low rectal cancer from the Oncology Center Mansoura University and San Raffaele University Hospital in Milan were randomly assigned to either TaTME or Lap TME. Results: 18 patients were operated by TaTME versus 20 patients by LapTME. Mean BMI was significantly higher in the TaTME group (30.74±7.79) versus the LapTME group (25.99±4.68) (p=0.03). TaTME was associated with more transanal specimen extraction (60% VS 20%, p=0.03). No significant differences were detected in CRM, DRM, peri or postoperative complications or conversion rates with more reported Clavien-Dindo grade III complications in TaTME group (p=0.29). Conclusions: TaTME facilitated rectal cancer surgery in obese patients and increased the chance of transanal specimen extraction with equivalent oncologic outcomes to conventional laparoscopic TME. Further studies are recommended to build better evidence.