Abstract:

Futher discussion on the progress and controversy and prospect of the procedure of transanal total mesorectal excision        ZHANG Zhong-tao,YAO Hong-wei.Department of General Surgery，Beijing Friendship Hospital，Capital Medical University ＆ National Clinical Research Center for Digestive Diseases，Beijing 100050，China
Corresponding author: ZHANG Zhong-tao，E-mail:zhangzht@
medmail.com.cn
Abstract    In recent years，the most controversial progress rectal surgery is more than transanal total mesorectal excision (TaTME). Compared with the traditional TME，the difficulty and risk of TaTME is greater，the learning curve is longer and the surgical indication is narrower; however，the advantage of TaTME is also very obvious，the implementation of higher quality TME procedure can be got in low rectal cancer patients even with "difficult pelvic". Others advantages include the distal margin of more ensure，less surgical trauma，even the natural orifice transluminal endoscopic surgery (NOTES) concept. In September 2017，“Consensus and Surgical Guidelines for Transanal Total Mesorectal Excision in Rectal Cancer (Version. 2017)” was published，which play an important role in standardizing the indications，operation and training of TaTME procedure. It arouses the attention of domestic counterparts and the attention of international counterparts. However，the domestic TaTME related clinical trials are rare，especially the multicenter，national research. In the future，based upon participating in national and international TaTME clinical trials，and structured training，the surgeon can carry out TaTME standard operation. Then，high levels of Chinese TaTME clinical research results based on evidence-based medicine" evidence can be obtained，which would be the basis of “Chinese guideline of TaTME Clinical Practice”. Therefore，it is foreseeable that TaTME will also go ahead in the dispute.

Key words: rectal cancer, total mesorectal excision, transanal total mesorectal excision, structured training, registry study, clinical trial

摘要：

近年来，中低位直肠癌手术方式中最具争议的进展莫过于经肛全直肠系膜切除（TaTME）。相较于传统经腹全直肠系膜切除（TME）手术，TaTME的难度和风险更大，且学习曲线更长，适应证更窄，但其优势同样也很明显，能够为“困难骨盆”的中低位直肠癌病人实施更高质量的TME手术，标本的远端切缘更有保证，手术创伤更小，甚至体现自然腔道内镜手术（NOTES）的理念。2017年9月，我国《直肠癌经肛全直肠系膜切除专家共识与手术操作指南（2017版）》的发布对于规范国内TaTME手术适应证、手术操作和培训，具有重要作用。然而，国内TaTME相关的临床研究却较少，尤其是多中心、全国性的研究，同时也缺少结构化培训及教程。未来，期待在参加全国性和国际性TaTME临床研究的基础上，开展广泛的结构化培训和临床试验，以使TaTME操作标准化，并获得基于我国TaTME临床研究结果的高级别循证医学证据，在不久的将来形成我国的TaTME临床实践指南，使更多的直肠癌病人获益。因此，可以预见，TaTME手术还将在争议中前行。

关键词: 直肠癌, 全直肠系膜切除, 经肛全直肠系膜切除, 结构化培训, 登记研究, 临床试验