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Surgical Endoscopy
Published in: Surgical Endoscopy 3/2018

Open Access 01-03-2018 | Consensus Statement

St.Gallen consensus on safe implementation of transanal total mesorectal excision

Authors: Michel Adamina, Nicolas C. Buchs, Marta Penna, Roel Hompes, on behalf of the St.Gallen Colorectal Consensus Expert Group

Published in: Surgical Endoscopy | Issue 3/2018

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Abstract

Background

The management of rectal cancer has evolved over the years, including the recent rise of Transanal Total Mesorectal Excision (TaTME). TaTME addresses the limitations created by the bony confines of the pelvis, bulky tumours, and fatty mesorectum, particularly for low rectal cancers. However, guidance is required to ensure safe implementation and to avoid the pitfalls and potential major morbidity encountered by the early adopters of TaTME. We report a broad international consensus statement, which provides a basis for optimal clinical practice.

Methods

Forty international experts were invited to participate based on clinical and academic achievements. The consensus statements were developed using Delphi methodology incorporating three successive rounds. Consensus was defined as agreement by 80% or more of the experts.

Results

A total of 37 colorectal surgeons from 20 countries and 5 continents (Europe, Asia, North and South America, Australasia) contributed to the consensus. Participation to the iterative Delphi rounds was 100%. An expert radiologist, pathologist, and medical oncologist provided recommendations to maximize relevance to current practice. Consensus was obtained on all seven different chapters: patient selection and surgical indication, perioperative management, patient positioning and operating room set up, surgical technique, devices and instruments, pelvic anatomy, TaTME training, and outcomes analysis.

Conclusions

This multidisciplinary consensus statement achieved more than 80% approval and can thus be graded as strong recommendation, yet acknowledging the current lack of high level evidence. It provides the best possible guidance for safe implementation and practice of Transanal Total Mesorectal Excision.
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Metadata
Title
St.Gallen consensus on safe implementation of transanal total mesorectal excision
Authors
Michel Adamina
Nicolas C. Buchs
Marta Penna
Roel Hompes
on behalf of the St.Gallen Colorectal Consensus Expert Group
Publication date
01-03-2018
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 3/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-017-5990-2

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