Intraoperative difficulties/accidents and postoperative complications of transanal total mesorectal excision: A nationwide registry study        LI Yang*, REN Ming-yang, ZHANG Hong-yu, et al.*Department of General Surgery,Beijing Friendship Hospital, Capital Medical University;National Clinical Research Center for Digestive Diseases;Clinical Practice and Research Center for Colorectal Neoplasm, Capital Medical University, Beijing 100050, China
Corresponding authors: YAO Hong-wei, E-mail：yaohongwei@ccmu.edu.cn; ZHANG Zhong-tao,E-mail：zhangzht@ccmu.edu.cn
LI Yang, REN Ming-yang, ZHANG Hong-yu, WANG Quan, XU Qing, YU Gang, CHEN Jian-zhi, ZHANG Hong, XIAO Yi, WU Miao are the first authors who contributed equally to the article
LI Yang, REN Ming-yang, ZHANG Hong-yu, WANG Quan, XU Qing, YU Gang, CHEN Jian-zhi, ZHANG Hong, XIAO Yi, WU Miao, LIU Yi-shan, YAO Hong-wei, ZHANG Zhong-tao on behalf of Chinese taTME Registry Collaborative Team
Abstract    Objective    To introduce the intraoperative difficulties/accidents and postoperative complications of transanal total mesorectal excision (taTME) based on the data registered in the Chinese taTME Registry Collaborative (CTRC). Methods    Between November 15, 2017, and June 30, 2022, clinical data of 1,926 patients undergoing taTME procedure registered in the CTRC database from 43 domestic centers were collected retrospectively. The occurrence of difficulties /accidents and postoperative complications in taTME surgery were statistically analyzed. Results    (1) 1926 cases of taTME were included in the analysis of this study. There were 1327 males (68.9%) and 599 females (31.1%) with median age of 61 (53~68) years old; (2) 34.3% of the patients encountered intraoperative difficulties /accidents, among which the most common intraoperative problems were pelvic operation field smoke(22.3%) and unstable pelvic CO2 perfusion pressure(18.0%); (3) The postoperative complications occurred in 296 cases (15.4%). Anastomotic leakage was the most common complication, with an incidence of 5.9%, among which Grade B anastomotic leakage (2.2%) was the most common. The incidence of postoperative fever was 4.3% (82/1,926). Intestinal obstruction occurred in 41 cases (2.1%). Urinary retention occurred in 29 cases (1.5%). 15 cases (0.8%) developed wound complications. Conclusion    The most common intraoperative difficulties were pelvic surgical field smoke and unstable pelvic CO2 perfusion pressure; Postoperative complications, in order of incidence from highest to lowest, were anastomotic leakage (Grade B most common), postoperative fever, ileus, urinary retention, incision infection and etc. To further reduce  problems/accidents and postoperative complications in taTME surgery, structured training on taTME surgery is indispensable.