EP2008 - Implementing TaTME after Total Neoadjuvant Therapy: Early Oncologic Outcomes from a Tertiary Center in a Low- and Middle-Income Country

Purpose/Background: Total neoadjuvant therapy (TNT) followed by minimally invasive surgery has become the standard approach for locally advanced low- to mid-rectal cancers. However, achieving high-quality total mesorectal excision (TME) after TNT remains technically challenging. Transanal TME (TaTME) provides an ergonomic and anatomically precise approach to these challenges and may be particularly valuable in low- and middle-income countries (LMICs) where access to robotic platforms is limited. The implementation of advanced minimally invasive techniques in LMICs is often constrained by the high cost of robotic systems and infrastructure limitations. In this context, TaTME offers a cost-effective and technically precise alternative to achieving high-quality TME in complex rectal cancers. This study evaluated the feasibility, safety, and short-term oncologic outcomes of TaTME following TNT during its early implementation phase at the Philippine General Hospital.

Methods/Interventions: We performed a retrospective descriptive study of 10 adult patients with locally advanced low- to mid-rectal cancer, who underwent total neoadjuvant therapy (TNT) followed by transanal total mesorectal excision (TaTME), between December 2024 and September 2025. Data on demographics, treatment details, operative variables (operative time and estimated blood loss, EBL), and postoperative outcomes were collected. Endpoints included time to return of bowel function, postoperative length of stay (LOS), 30-day morbidity, 30-day mortality, specimen quality, R0 resection rate, and pathologic complete response (pCR) rate. Continuous variables are presented as medians with interquartile ranges (IQR), and categorical variables as frequencies with percentages.

Results/Outcomes: The median age of the patients was 66.5 years (IQR, 51-69.3), and most (80%) were male. All patients completed TNT, with pretreatment stage and the TNT regimen summarized in the table. Median operative time was 590 minutes (IQR, 456-724), with no intraoperative complications or conversions. Median EBL was 650 mL. Median time to return of bowel function was 1 day, and median postoperative LOS was 4 days (IQR, 3-6.5). One patient (10%) had both prolonged postoperative ileus and pulmonary embolism which was managed medically. No mortalities were reported. All patients had gross specimens that were graded as "complete." All were R0 resections. Two patients (20%) achieved a pCR.

Conclusion/Discussion: TaTME following TNT is feasible and safe in a resource-constrained LMIC setting, achieving short-term oncologic and clinical outcomes comparable to international benchmarks. With structured training and careful patient selection, TaTME represents a practical strategy to expand access to high-quality rectal cancer surgery in LMICs without reliance on costly robotic platforms. These findings support the adoption of innovative surgical techniques in similar resource-limited environments.