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Meta-Analysis
. 2022 Apr;36(4):2221-2232.
doi: 10.1007/s00464-022-09090-4. Epub 2022 Feb 25.

UEG and EAES rapid guideline: Systematic review, meta-analysis, GRADE assessment and evidence-informed European recommendations on TaTME for rectal cancer

Marco Milone  1 , Michel Adamina  2   3 , Alberto Arezzo  4 , Nona Bejinariu  5 , Luigi Boni  6 , Nicole Bouvy  7 , F Borja de Lacy  8 , Raphaëla Dresen  9 , Konstantinos Ferentinos  10   11 , Nader K Francis  12 , Joe Mahaffey  13 , Marta Penna  14 , George Theodoropoulos  15 , Katerina Maria Kontouli  16 , Dimitris Mavridis  16   17 , Per Olav Vandvik  18 , Stavros A Antoniou  19
Affiliations
Meta-Analysis

UEG and EAES rapid guideline: Systematic review, meta-analysis, GRADE assessment and evidence-informed European recommendations on TaTME for rectal cancer

Marco Milone et al. Surg Endosc. 2022 Apr.

Abstract

Background: Evidence and practice recommendations on the use of transanal total mesorectal excision (TaTME) for rectal cancer are conflicting.

Objective: We aimed to summarize best evidence and develop a rapid guideline using transparent, trustworthy, and standardized methodology.

Methods: We developed a rapid guideline in accordance with GRADE, G-I-N, and AGREE II standards. The steering group consisted of general surgeons, members of the EAES Research Committee/Guidelines Subcommittee with expertise and experience in guideline development, advanced medical statistics and evidence synthesis, biostatisticians, and a guideline methodologist. The guideline panel consisted of four general surgeons practicing colorectal surgery, a radiologist with expertise in rectal cancer, a radiation oncologist, a pathologist, and a patient representative. We conducted a systematic review and the results of evidence synthesis by means of meta-analyses were summarized in evidence tables. Recommendations were authored and published through an online authoring and publication platform (MAGICapp), with the guideline panel making use of an evidence-to-decision framework and a Delphi process to arrive at consensus.

Results: This rapid guideline provides a weak recommendation for the use of TaTME over laparoscopic or robotic TME for low rectal cancer when expertise is available. Furthermore, it details evidence gaps to be addressed by future research and discusses policy considerations. The guideline, with recommendations, evidence summaries, and decision aids in user-friendly formats can also be accessed in MAGICapp: https://app.magicapp.org/#/guideline/4494 .

Conclusions: This rapid guideline provides evidence-informed trustworthy recommendations on the use of TaTME for rectal cancer.

Keywords: Clinical practice guideline; EAES; GRADE; Rectal cancer; TaTME; Transanal TME.

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Conflict of interest statement

Marco Milone, Alberto Arezzo, Elleke Dresen, George Theodoropoulos, Joe Mahaffey, Konstantinos Ferentinos, Luigi Boni, Marta Penna, Michel Adamina, Nader K. Francis, Nicole Bouvy, Nona Bejinariu, Katerina Maria Kontouli, Dimitris Mavridis, Per Olav Vandvik, and Stavros A. Antoniou have no direct conflicts of interest or financial ties to disclose. Indirect conflicts were documented and managed as per G-I-N standards. Detailed conflict of interest statements of all contributors can be found in http://osf.io/65vkq.

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