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. 2019 Sep;14(3):353-365.
doi: 10.5114/wiitm.2019.82798. Epub 2019 Feb 8.

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

Dezheng Lin  1   2 , Zhaoliang Yu  2   3 , Wenpei Chen  4 , Jiancong Hu  1   2 , Xuming Huang  1   2 , Zhen He  2   3 , Yi-Feng Zou  2   3 , Xiangan Yu  2   3 , Xuefeng Guo  1   2 , Xiao-Jian Wu  2   3
Affiliations

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

Dezheng Lin et al. Wideochir Inne Tech Maloinwazyjne. 2019 Sep.

Abstract

Introduction: The benefit of transanal total mesorectal excision (TaTME) for mid and low rectal cancer is conflicting.

Aim: To assess and compare the short-term outcomes of TaTME with conventional laparoscopic total mesorectal excision (LaTME) for middle and low rectal cancer.

Material and methods: We searched PubMed, Embase and Cochrane Library databases for studies addressing TaTME versus conventional LaTME for rectal cancer between 2008 and December 2018. Randomized controlled trials (RCTs) and retrospective studies which compared TaTME with LaTME were included.

Results: Twelve retrospective case-control studies were identified, including a total of 899 patients. We did not find significant differences in overall intraoperative complications, blood loss, conversion rate, operative time, overall postoperative complication, anastomotic leakage, ileus, or urinary morbidity. Also no significant differences in oncological outcomes including circumferential resection margin (CRM), positive CRM, distal margin distance (DRM), positive DRM, quality of mesorectum, number of harvested lymph nodes, temporary stoma or local recurrence were found. Although the TaTME group had better postoperative outcomes (readmission, reoperation, length of hospital stay) on average, the difference did not reach statistical significance.

Conclusions: Transanal total mesorectal excision offers a safe and feasible alternative to LaTME although the clinicopathological features were not superior to LaTME in this study. Currently, with the lack of evidence on benefits of TaTME, further evaluation of TaTME requires large randomized control trials to be conducted.

Keywords: laparoscopic total mesorectal excision; meta-analysis; rectal cancer; transanal total mesorectal excision.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of trial identification, screening, inclusion and exclusion
Figure 2
Figure 2
Forest plots describing estimated blood loss (A), conversion events (B), operative time (C) and intraoperative complications (D) between TaTME and LaTME
Figure 3
Figure 3
Forest plots describing postoperative outcomes: overall postoperative complication (A), anastomotic leakage (B), ileus (C), urinary morbidity (D) between TaTME and LaTME
Figure 4
Figure 4
Forest plots describing postoperative outcomes: readmission (A), reoperation (B), length of hospital stay (C) between TaTME and LaTME
Figure 5
Figure 5
Forest plots describing oncological outcomes: CRM (A), positive CRM (B), DRM (C), positive DRM (D) between TaTME and LaTME
Figure 6
Figure 6
Forest plots describing oncological outcomes: quality of mesorectum (A), number of harvested lymph nodes (B) and temporary stoma (C) between TaTME and LaTME
Figure 7
Figure 7
Forest plot describing oncological outcome of local recurrence
Figure 8
Figure 8
Funnel plot showing publication bias based on overall complication rate
See this image and copyright information in PMC

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