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. 2018 Nov 19;7(11):448.
doi: 10.3390/jcm7110448.

Comparison of Short-Term Clinical and Pathological Outcomes after Transanal versus Laparoscopic Total Mesorectal Excision for Low Anterior Rectal Resection Due to Rectal Cancer: A Systematic Review with Meta-Analysis

Mateusz Rubinkiewicz  1 , Agata Czerwińska  2 , Piotr Zarzycki  3 , Piotr Małczak  4   5 , Michał Nowakowski  6 , Piotr Major  7   8 , Andrzej Budzyński  9   10 , Michał Pędziwiatr  11   12
Affiliations

Comparison of Short-Term Clinical and Pathological Outcomes after Transanal versus Laparoscopic Total Mesorectal Excision for Low Anterior Rectal Resection Due to Rectal Cancer: A Systematic Review with Meta-Analysis

Mateusz Rubinkiewicz et al. J Clin Med. .

Abstract

Background: Transanal total mesorectal excision (TaTME) is a new technique that is designed to overcome the limits of the open and laparoscopic approach for rectal resections.

Objective: This study is designed to compare TaTME with standard laparoscopic TME (LaTME).

Methods: We searched Medline, Embase, and Scopus databases covering a up to October 2018. Inclusion criteria for study enrolment: (1) study comparing laparoscopic resection of rectal cancer vs. TaTME for rectal malignancy, (2) reporting of overall morbidity, operative time, or major complications.

Results: Eleven non-randomized studies were eligible with a total of 778 patients. We found statistical significant differences in regard to major complications in favour of TaTME (RR = 0.55; 95% CI 0.31⁻0.97; p = 0.04). We did not found significant differences regarding overall complications intraoperative adverse effects, operative time, anastomotic leakage, intra-abdominal abscess occurrence, Surgical Site Infection, reoperations, Length of stay, completeness of mesorectal excision, R0 resection rate, number of harvested lymph nodes, circumferential resection margin, and distal resection margin.

Conclusions: This meta-analysis shows benefits of TaTME technique regarding major postoperative complications. Regarding clinicopathological features transanal approach is not superior to LaTME. Currently, the quality of the evidence on benefits of TaTME is low due to lack of randomized controlled trials, which needs to be taken into consideration in further evaluation of the technique. Further evaluation of TaTME require conducting large randomized control trials.

Keywords: laparoscopic; rectal cancer; total mesorectal excision; transanal.

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Conflict of interest statement

The authors declare no conflict of interests.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic reviews (PRISMA) Flowchart.
Figure 2
Figure 2
Overall morbidity. CI—Confidence Interval; df—degrees of freedom, M-H—Mantel-Haenszel test. WMD and RR are presented on the graphs as squares, and overall WMD and RR is presented as diamond.
Figure 3
Figure 3
Major complications (Clavien-Dindo III–V). CI—Confidence Interval; df—degrees of freedom, M-H—Mantel-Haenszel test. WMD and RR are presented on the graphs as squares, and overall WMD and RR is presented as diamond.
Figure 4
Figure 4
Intraoperative Adverse Effects. CI—Confidence Interval; df—degrees of freedom, M-H—Mantel-Haenszel test. WMD and RR are presented on the graphs as squares, and overall WMD and RR is presented as diamond.
Figure 5
Figure 5
Operative time. CI—Confidence Interval; df—degrees of freedom, M-H—Mantel-Haenszel test. WMD and RR are presented on the graphs as squares, and overall WMD and RR is presented as diamond.
Figure 6
Figure 6
Anastomotic leakage. CI—Confidence Interval; df—degrees of freedom, M-H—Mantel-Haenszel test. WMD and RR are presented on the graphs as squares, and overall WMD and RR is presented as diamond.
Figure 7
Figure 7
Completeness of mesorectal excision. CI—Confidence Interval; df—degrees of freedom, M-H—Mantel-Haenszel test. WMD and RR are presented on the graphs as squares, and overall WMD and RR is presented as diamond.
Figure 8
Figure 8
R0 resection rate. CI—Confidence Interval; df—degrees of freedom, M-H—Mantel-Haenszel test. WMD and RR are presented on the graphs as squares, and overall WMD and RR is presented as diamond.
Figure 9
Figure 9
Number of harvested lymph nodes. CI—Confidence Interval; df—degrees of freedom; IV—inverse variance.
Figure 10
Figure 10
Length of distal resection margin. CI—Confidence Interval; df—degrees of freedom; IV—inverse variance. WMD and RR are presented on the graphs as squares, and overall WMD and RR is presented as diamond.
Figure 11
Figure 11
Circumferential resection margin. CI—Confidence Interval; df—degrees of freedom; IV—inverse variance. WMD and RR are presented on the graphs as squares, and overall WMD and RR is presented as diamond.
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