Ann Surg Treat Res.  2021 Feb;100(2):86-99. 10.4174/astr.2021.100.2.86.

Short- and mid-term outcomes of transanal versus laparoscopic total mesorectal excision for low rectal cancer: a meta-analysis

• Ren J
• Luo H
• Liu S
• Wang B
• Wu F

• KMID: 2512504
• DOI: http://doi.org/10.4174/astr.2021.100.2.86

Abstract

Purpose
The current meta-analysis combining mid and low rectal cancer with no meta-analysis only for low rectal cancer was seen. This meta-analysis was to compare the short- and mid-term outcomes of the transanal total mesorectal excision (TaTME) vs. laparoscopic total mesorectal excision (LaTME) for low rectal cancer.
Methods
A systematic literature search was conducted using the web-based databases; China National Knowledge Infrastructure, Chinese BioMedical Database, PubMed, Embase, Cochrane Central Register of Controlled Trials, and Wanfang Database. Randomized controlled trials (RCTs) were evaluated using the Jadad scale and non-RCTs (NRCs) were evaluated using the Newcastle-Ottawa Scale.
Results
Ten studies (2 RCTs and 8 NRCs) involving 772 patients were included. Among them, 378 patients underwent TaTME and 394 patients underwent LaTME. Compared with the LaTME group, the conversion rate was low (risk ratio [RR], 0.25; 95% confidence interval [CI], 0.11–0.54; P < 0.001), the circumferential resection margin (CRM) involvement was low (RR, 0.48; 95% CI, 0.27–0.86; P = 0.010), and the hospital stay was short (mean difference, –1.72; 95% CI, –2.89 to –0.55; P = 0.004) in the TaTME group. No significant differences were seen in the mesorectal resection quality, CRM distance, distal resection margin (DRM) involvement, DRM distance, local R1 resection, intraoperative complications, morbidity, anastomotic leakage, severe morbidity, mortality, operative time, intraoperative blood loss, harvested lymph nodes, and local recurrence rate (P > 0.05).
Conclusion
The TaTME is a promising surgical technique and is fully a safe and efficacious option in managing low rectal cancer.

Keyword

Laparoscopic surgery; Rectal cancer; Transanal endoscopic surgical procedures

Figure

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  Fig. 1 Schematic illustration for literature search and inclusion of studies in the meta-analysis.

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  Fig. 2 Forest plots of risk ratio between transanal total mesorectal excision (TaTME) group and laparoscopic total mesorectal excision (LaTME) group. (A) Conversion. (B) Mesorectal resection quality. (C) Circumferential resection margin involvement. (D) Distal resection margin involvement. (E) Local R1 resection. (F) Intraoperative complications. (G) Morbidity. (H) Anastomotic leakage. (I) Severe morbidity. (J) Mortality. (K) Local recurrence. CI, confidence interval; df, degree of freedom.

• 

  Fig. 3 Forest plots of mean difference between transanal total mesorectal excision (TaTME) group and laparoscopic total mesorectal excision (LaTME) group. (A) Circumferential resection margin distance. (B) Distal resection margin distance. (C) Operative time. (D) Intraoperative blood loss. (E) Harvested lymph nodes. (F) Hospital stay. SD, standard deviation; IV, inverse variance methods; CI, confidence interval; df, degree of freedom.

• 

  Fig. 4 Funnel plot for conversion (A) and morbidity (B). SE, standard error; OR, odds ratio.

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