Discussion on specimen extraction method in transanal total mesorectal excision for rectal cancer        LIU Ding-sheng, ZHANG Hong. Department of General Surgery, Shengjing Hospital, China Medical University, Shenyang 110004, China
Corresponding author: ZHANG Hong, E-mail: haojiubujian
1203@sina.cn
Abstract    The development of transanal total mesorectal excision (taTME) overturned the traditional top-down rectal dissociation mode. The bottom-up dissociation mode solved the difficult problem of distal pelvic rectum dissociation, and the distal resection margin cannot be confirmed. At present, the research on taTME mainly focuses on the surgical technique and local anatomy, the prevention and treatment of complications, and the oncological effect. Not enough attention had been paid to the technical details of whether the resected specimen was taken out through the anus or through the abdominal auxiliary incision. The process of specimen extraction was closely related to various adverse postoperative outcomes of taTME. Based on the experience of more than 150 cases of taTME in a single center, specimen extraction through the anus has the advantages of reducing surgical site infection and incisional hernias, less pain, and better cosmetic effect. However, it also possessed some shortcomings, such as the destruction of the integrity of the mesentery, the damage of the marginal vessels, the insufficient resection of the proximal bowel, the incomplete dissection of the lymph node at the second station, and the poor anal function after the operation. Therefore, it should be comprehensively judged whether it is suitable to take samples through anus by combining the measurement of tumor diameter, angle of levator ani muscle, area of mesorectum under MRI before the operation, and the evaluation of anal sphincter tension and proximal intestinal tube length during operation.