Impact of Two-Team Surgery on Short- and Long-Term Outcomes of Transanal Total Mesorectal Excision for Rectal Cancer.

Aim: Minimally invasive total mesorectal excision is widely used in rectal cancer surgery because of its better surgical field-of-view and recognition of microanatomy, compared with open surgery; however, it remains difficult to perform deep pelvic manipulation. Transanal total mesorectal excision (TaTME) is expected to overcome these difficulties, especially in two-team surgeries with simultaneous abdominal and transanal approaches. Methods: Data were collected from patients with rectal cancer who underwent TaTME between January 2012 and December 2019 at 26 specialized rectal cancer institutions in Japan. Patients in the two-team surgery group were propensity score-matched in a 2:1 ratio to those in the one-team surgery group. Surgical outcomes, postoperative complications, transanal approach-related outcomes, and survival rates were compared between the two surgical groups. Results: Overall, 444 patients (296 and 148 in the two- and one-team surgery groups, respectively) were included in the analyses. The median operation time was significantly shorter ( Conclusion: Two-team surgery has advantages of shorter operation time, decreased estimated blood loss, increased number of lymph nodes dissected and decreased positive distal margin rates and potential to decrease recurrence rates.