ArticleSurgical endoscopy2020
Defining the learning curve for transanal total mesorectal excision for rectal adenocarcinoma.
Article in Surgical endoscopy, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 59 papers, 7 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
59 citing papers in PubMed, 7 syntheses or guidelines pooled it.
- EAES, ESCP, and ESGAR clinical practice guideline update on taTME for rectal cancer.Surgical endoscopy · 2026Guideline
- Transanal versus transabdominal total mesorectal excision for rectal cancer in minimally invasive surgery: meta-analysis.BJS open · 2025Pooled it
- Transanal ileal pouch anal anastomosis for ulcerative colitis in children and adults: a systematic review and meta-analysis.Pediatric surgery international · 2022Pooled it
- The learning curve of laparoscopic, robot-assisted and transanal total mesorectal excisions: a systematic review.Surgical endoscopy · 2022Pooled it
- UEG and EAES rapid guideline: Systematic review, meta-analysis, GRADE assessment and evidence-informed European recommendations on TaTME for rectal cancer.Surgical endoscopy · 2022Guideline
- A systematic review and meta-analysis of robotic-assisted transabdominal total mesorectal excision and transanal total mesorectal excision: which approach offers optimal short-term outcomes for mid-to-low rectal adenocarcinoma?Techniques in coloproctology · 2021Pooled it
- P338: summarizing measures of proficiency in transanal total mesorectal excision-a systematic review.Surgical endoscopy · 2021Pooled it
- Long-term oncologic outcomes after transanal total mesorectal excision: a single-center cohort with a minimum of 5-year follow-up.Surgical endoscopy · 2026Article
- Impact of Hospital Volume on Local Recurrence of Rectal Cancer After Transanal Total Mesorectal Excision: A Nationwide Multicenter Cohort Study in Japan.Annals of surgical oncology · 2026Article
- Comparison of transanal total mesorectal excision and robotic total mesorectal excision for rectal cancer: an inverse probability of treatment weighting analysis.World journal of surgical oncology · 2025Article
- Review
- Oncologic outcomes following transanal total mesorectal excision: the United States experience.Surgical endoscopy · 2024Observational
- Article
- Comparison of the short-term surgical outcomes of lateral lymph node dissection for low rectal cancer using a robotic-assisted transabdominal approach alone or supported by a transanal approach.Surgical endoscopy · 2024Article
- Local Recurrence of Rectal Cancer After Transanal Total Mesorectal Excision and Risk Factors: A Nationwide Multicenter Cohort Study in Japan.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2024Article
- Prediction of learning curves of wired and wireless intraoral scanners.Scientific reports · 2023Article
- Exfoliate cancer cell analysis in rectal cancer surgery: comparison of laparoscopic and transanal total mesorectal excision, a pilot study.Annals of coloproctology · 2023Article
- Transanal total mesorectal excision (TaTME) in rectal cancer treatment within an expert center.Scientific reports · 2023Article
- Recurrence following transanal total mesorectal excision for rectal cancer: a monocentric retrospective series of technically difficult cases.Annals of coloproctology · 2023Article
- A Cost Overview of Minimally Invasive Total Mesorectal Excision in Rectal Cancer Patients: A Population-based Cohort in Experienced Centres.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2023Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundEarly observational data suggest that this approach is safe and feasible, but it is technically challenging and the learning curve has not yet been determined. The objective of this study was to determine the number of cases required achieve proficiency in transanal total mesorectal excision (TA-TME) for rectal adenocarcinoma.
methodsAll TA-TME cases performed from 03/2012-01/2017 at a single high-volume tertiary care institution for rectal adenocarcinoma were included. A cumulative summation (CUSUM) analysis was performed to determine the number of cases required to reach proficiency, defined as high-quality TME (complete or near-complete mesorectal envelope, negative distal (DRM), and circumferential resection (> 1 mm; CRM) margin). The acceptable and unacceptable rates of good quality TME were defined based on the incidence of high-quality TME in laparoscopic (unacceptable rate = 81.7%) and open (acceptable rate = 86.9%) arms of the ACOSOG Z6051 trial.
resultsA total of 87 consecutive cases were included with mean tumor height 4.8 cm (SD 2.7) and 80% (70/87) received neoadjuvant chemoradiation. Post-operative morbidity occurred in 44% (38/87) of cases, including 21% (18/87) readmissions. Median length of stay was 4 days [IQR 3-8]. A good quality TME was performed in 95% (83/87) of cases including 98% (85/87) negative CRM, 99% (86/87) negative DRM, and 99% (86/87) complete or near-complete mesorectal envelope. CUSUM analysis reported that the good quality TME rate reaches an acceptable rate after 51 cases overall, and 45 cases if abdominoperineal resections are excluded.
conclusionTA-TME is a complex technique that requires a minimum of 45-51 cases to reach an acceptable incidence of high-quality TME and lower operative duration.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.