Ann Surg Treat Res.  2021 Sep;101(3):167-180. 10.4174/astr.2021.101.3.167.

Meta-analysis of transanal versus laparoscopic total mesorectal excision for rectal cancer: a ‘New Health Technology’ assessment in South Korea

Affiliations
  • 1Division for New Health Technology Assessment, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
  • 2TaTME Assessment Committee, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
  • 3Division of Colorectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
  • 4Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 5Division of Colon and Rectal Surgery, Department of Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
  • 6Department of General Surgery, Ewha Womans University College of Medicine, Seoul, Korea
  • 7Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
  • 8Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
  • 9Department of Surgery, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea

Abstract

Purpose
Under the South Korea’s unique health insurance structure, any new surgical technology must be evaluated first by the government in order to consider whether that particular technology can be applied to patients for further clinical trials as categorized as ‘New Health Technology,’ then potentially covered by the insurance sometime later. The aim of this meta-analysis was to assess the safety and efficacy of transanal total mesorectal excision (TaTME) for rectal cancer, activated by the National Evidence-based Healthcare Collaborating Agency (NECA) TaTME committee.
Methods
We systematically searched Ovid-MEDLINE, Ovid-Embase, Cochrane, and Korean databases (from their inception until August 31, 2019) for studies published that compare TaTME with laparoscopic total mesorectal excision (LaTME). End-points included perioperative and pathological outcomes.
Results
Sixteen cohort studies (7 for case-matched studies) were identified, comprising 1,923 patients (938 TaTMEs and 985 LaTMEs). Regarding perioperative outcomes, the conversion rate was significantly lower in TaTME (risk ratio, 0.19; 95% confidence interval, 0.11–0.34; P < 0.001); whereas other perioperative outcomes were similar to LaTME. There were no statistically significant differences in pathological results between the 2 procedures.
Conclusion
Our meta-analysis showed comparable results in preoperative and pathologic outcomes between TaTME and LaTME, and indicated the benefit of TaTME with low conversion. Extensive evaluations of well-designed, multicenter randomized controlled trials are required to come to unequivocal conclusions, but the results showed that TaTME is a potentially beneficial technique in some specific cases. This meta-analysis suggests that TaTME can be performed for rectal cancer patients as a ‘New Health Technology’ endorsed by NECA in South Korea.

Keyword

Colorectal neoplasms; Laparoscopic total mesorectal excision; Meta-analysis; Systematic review; Transanal total mesorectal excision
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