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Meta-Analysis
. 2020 Apr;107(5):489-498.
doi: 10.1002/bjs.11566. Epub 2020 Mar 10.

Functional complaints and quality of life after transanal total mesorectal excision: a meta-analysis

J A G van der Heijden  1 , T Koëter  1 , L J H Smits  2 , C Sietses  3 , J B Tuynman  2 , A J G Maaskant-Braat  4 , B R Klarenbeek  1 , J H W de Wilt  1
Affiliations
Meta-Analysis

Functional complaints and quality of life after transanal total mesorectal excision: a meta-analysis

J A G van der Heijden et al. Br J Surg. 2020 Apr.

Abstract
in English, Spanish

Background: Total mesorectal excision (TME) gives excellent oncological results in rectal cancer treatment, but patients may experience functional problems. A novel approach to performing TME is by single-port transanal minimally invasive surgery. This systematic review evaluated the functional outcomes and quality of life after transanal and laparoscopic TME.

Methods: A comprehensive search in PubMed, the Cochrane Library, Embase and the trial registers was conducted in May 2019. PRISMA guidelines were used. Data for meta-analysis were pooled using a random-effects model.

Results: A total of 11 660 studies were identified, from which 14 studies and six conference abstracts involving 846 patients (599 transanal TME, 247 laparoscopic TME) were included. A substantial number of patients experienced functional problems consistent with low anterior resection syndrome (LARS). Meta-analysis found no significant difference in major LARS between the two approaches (risk ratio 1·13, 95 per cent c.i. 0·94 to 1·35; P = 0·18). However, major heterogeneity was present in the studies together with poor reporting of functional baseline assessment.

Conclusion: No differences in function were observed between transanal and laparoscopic TME.

Antecedentes: La escisión total del mesorrecto (total mesorectal excision, TME) proporciona excelentes resultados oncológicos en el tratamiento del cáncer de recto, pero los pacientes pueden presentar trastornos funcionales. Un abordaje novedoso para realizar la TME es mediante cirugía transanal mínimamente invasiva de puerto único. En esta revisión sistemática se evaluaron los resultados funcionales y la calidad de vida después de TME transanal (TaTME) y TME laparoscópica (LapTME). MÉTODOS: En mayo de 2019 se realizó una búsqueda exhaustiva en las bases de datos de Pubmed, Biblioteca Cochrane, EMBASE y en los registros de ensayos clínicos. Se utilizaron las guías PRISMA. Los datos para el metaanálisis se agruparon utilizando un modelo de efectos aleatorios.

Resultados: Se identificaron un total de 11.660 estudios, de los cuales se incluyeron 14 estudios y 6 resúmenes de congresos con 846 pacientes (599 TaTME/247 LapTME). Un número sustancial de pacientes presentó trastornos funcionales consistentes con el síndrome de resección anterior baja (low anterior resection syndrome, LARS). El metaanálisis no encontró diferencias significativas en los porcentajes de LARS grave entre los dos abordajes (razón de oportunidades, odds ratio, OR 1,13; i.c. del 95% 0,94-1,35; P = 0,18). Sin embargo, los estudios globalmente presentaron una gran heterogeneidad, así como una deficiente información sobre la evaluación funcional basal. CONCLUSIÓN: No se observaron diferencias en la función entre TaTME y LapTME.

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Figures

Figure 1
Figure 1
PRISMA diagram showing selection of articles for review TaTME, transanal total mesorectal excision; QoL, quality of life.
Figure 2
Figure 2
Meta‐analysis of the prevalence of major low anterior resection syndrome after transanal versus laparoscopic total mesorectal excision A Mantel–Haenszel random‐effects model was used for meta‐analysis. Risk ratios are shown with 95 per cent confidence intervals. The longest follow‐up data for each study were used. If a study favours laparoscopic total mesorectal excision (LapTME), fewer patients experienced major low anterior resection syndrome (LARS) in this group. TaTME, transanal total mesorectal excision.
See this image and copyright information in PMC

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