Transanal Total Mesorectal Excision with Laparoscopic Assistance in Treating Patients with Rectal Cancer

Inclusion Criteria

• New diagnosis of histologically confirmed adenocarcinoma of the rectum
• Rectal cancer originally staged as T1, T2, or T3, node negative (N0) or node positive (N1, N2) by pelvic magnetic resonance imaging (MRI)
• Eastern Cooperative Oncology Group (ECOG) performance status =< 2 (Karnofsky >= 60%)
• Circumferential radial margin not involved with tumor on pelvic MRI
• No evidence of metastasis on staging computed tomography (CT) or positron emission tomography (PET) CT scans of the chest, abdomen and pelvis
• Rectal cancer located within 10 cm from the anal verge based on proctoscopy and digital rectal examination (DRE)
• Complete preoperative colonoscopy demonstrating no synchronous colon cancer
• Participants must be eligible to undergo laparoscopic or robotic low anterior resection with or without a temporary diverting stoma, based on multidisciplinary tumor board consensus
• Ability to understand and the willingness to sign a written informed consent document

Exclusion Criteria

• Rectal cancer staged as T4 by pelvic MRI
• Participants with preoperatively staged T3, N1, or N2 tumors who return > 12 weeks following completion of neoadjuvant chemoradiation therapy (CRT)
• Severely symptomatic rectal tumors (near-completely obstructing, symptomatic bleeding)
• Tumors invading into the internal anal sphincter muscle based on DRE and pelvic MRI
• Fecal incontinence at baseline
• Prior history of rectal resection
• Prior history of colorectal cancer
• History of inflammatory bowel disease
• Uncontrolled concurrent illness including, but not limited to ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
• Pregnant women are excluded from this study; breastfeeding should be discontinued if the mother is treated with chemotherapy and/or radiation
• Subjects who cannot read or understand English