Interview by Zoe Garoufalia.

Transanal Total Mesorectal Excision (TaTME) is a relatively recent surgical procedure that was originally pioneered to overcome difficulties in addressing rectal cancer and especially low rectal cancer via a pure abdominal approach. It is quite a controversial technique, because despite initial data [1] showing non-inferiority to laparoscopic or open TME, a recent Norwegian report raised concern due to high rates of multifocal pelvic recurrences [2]. Nevertheless it is unclear whether these issues are related to the technique itself or to poor adherence to recommendations and insufficient training. Therefore, an international panel of expert surgeons supported by 14 international surgical societies was appointed to provide an up-to-date consensus on the safe implementation and application of TaTME.

Danilo Miskovic, Director of Education and Consultant Colorectal Surgeon in St Mark’s Hospital in London and Roel Hompes, Consultant Colorectal and Oncologic Surgeon in AUMC (Amsterdam University Medical Centres) in Amsterdam, gave us a brief introduction to the new consensus, as co-authors of the new guidance.

Mr Miskovic underlines,

‘A safe framework, within which clinicians can operate and develop this technique further, is very important, given its potential risk for regional multifocal recurrences. The lack of high level evidence led the expert panel to the creation of a guidance statement that is practical, can be easily applied and is supported by a large number of international experts in the field, as well as surgical societies around the world.’

This project is led by the European Society of Coloproctology (ESCP) but also includes important collaborations with a several international societies such as ASCRS, EAES, SAGES, ACPGBI, ECCO, ESSO, CSCRS, CSLES, CSSANZ, JSES, SACP, SBCP and the Swiss-MIS.

The three main areas that are covered by the new consensus are:

  1. Which patients are eligible for TaTME - indications
  2. How do we measure quality and outcome of this procedure
  3. How surgeons should be trained before operating independently

Due to lack of high quality evidence on this procedure, an adapted Delphi method and focus group discussion approach were utilised for the production of the current project. He also highlighted that the new guidance is not the final statement, but a basis for discussion with a potential for change depending on the evidence arising:

‘This is an ongoing process’ he says and ‘the current document is purely a documentation of the current expert opinion’.

Mr Hompes reminds us that this guidance statement is dynamic. He underlines: ‘the power of ESCP’s members’ and invites them to comment; he doesn’t only invite surgeons that perform TaTME, but also colorectal surgeons who use other techniques and have an opinion about how TaTME should be used. These comments will be valuable for further improvement of the current statements in terms of areas of focus that have not been thoroughly described. He also notes:

‘This will be a dynamic process that will further strengthen these guidance statements’.

Mr Danilo Miskovic is the Director of Education and Consultant Colorectal Surgeon in St Mark’s Hospital in London.

Mr Roel Hompes is Colorectal and Oncologic Surgeon, in AUMC - University of Amsterdam, Amsterdam, Netherlands (since October 2017).

For more information please find the new guidance statement here:


  1. Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J, et al.; TaTME Registry Collaborative. (2017) Transanal Total Mesorectal Excision: International Registry Results of the First 720 cases. Ann Surg., 266(1):111-117.
  2. Larsen SG, Pfeffer F, Kørner H; Norwegian Colorectal Cancer Group. (2019) Norwegian moratorium on transanal total mesorectal excision. Br J Surg., 106(9):1120-1121.
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