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Meta-Analysis
. 2024 Aug;38(8):4431-4444.
doi: 10.1007/s00464-024-10934-4. Epub 2024 Jun 19.

Functional outcomes and quality of life following open versus laparoscopic versus robot-assisted versus transanal total mesorectal excision in rectal cancer patients: a systematic review and meta-analysis

Ritch T J Geitenbeek  1   2 , Thijs A Burghgraef  3   4 , Carmen A Moes  4 , Roel Hompes  5   6 , Adelita V Ranchor  7 , Esther C J Consten  3   4 ; MIRECA study group
Collaborators, Affiliations
Meta-Analysis

Functional outcomes and quality of life following open versus laparoscopic versus robot-assisted versus transanal total mesorectal excision in rectal cancer patients: a systematic review and meta-analysis

Ritch T J Geitenbeek et al. Surg Endosc. 2024 Aug.

Abstract

Background: The standard surgical treatment for rectal cancer is total mesorectal excision (TME), which may negatively affect patients' functional outcomes and quality of life (QoL). However, it is unclear how different TME techniques may impact patients' functional outcomes and QoL. This systematic review and meta-analysis evaluated functional outcomes of urinary, sexual, and fecal functioning as well as QoL after open, laparoscopic (L-TME), robot-assisted (R-TME), and transanal total mesorectal excision (TaTME).

Methods: A systematic review and meta-analysis, based on the preferred reporting items for systematic reviews and meta-analysis statement, were conducted (PROSPERO: CRD42021240851). A literature review was performed (sources: PubMed, Medline, Embase, Scopus, Web of Science, and Cochrane Library databases; end-of-search date: September 1, 2023), and a quality assessment was performed using the Methodological index for non-randomized studies. A random-effects model was used to pool the data for the meta-analyses.

Results: Nineteen studies were included, reporting on 2495 patients (88 open, 1171 L-TME, 995 R-TME, and 241 TaTME). Quantitative analyses comparing L-TME vs. R-TME showed no significant differences regarding urinary and sexual functioning, except for urinary function at three months post-surgery, which favoured R-TME (SMD [CI] -0 .15 [- 0.24 to - 0.06], p = 0.02; n = 401). Qualitative analyses identified most studies did not find significant differences in urinary, sexual, and fecal functioning and QoL between different techniques.

Conclusions: This systematic review and meta-analysis highlight a significant gap in the literature concerning the evaluation of functional outcomes and QoL after TME for rectal cancer treatment. This study emphasizes the need for high-quality, randomized-controlled, and prospective cohort studies evaluating these outcomes. Based on the limited available evidence, this systematic review and meta-analysis suggests no significant differences in patients' urinary, sexual, and fecal functioning and their QoL across various TME techniques.

Keywords: Functional outcomes; Meta-analysis; Quality of life; Rectal cancer; Systematic review; Total mesorectal excision.

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Conflict of interest statement

Esther Consten is a proctor for Intuitive Surgical and received a grant from this organization for the Vantage trial. No (financial) support from this organization has been received for the submitted manuscript. Neither have there been any other activities or relations that have influenced the submitted work. Drs. Ritch Geitenbeek, Thijs Burghgraef, Carmen Moes, Roel Hompes, and Adelita Ranchor have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
Flowchart depicting study selection. FO functional outcomes; n number; QoL quality of life
Fig. 2
Fig. 2
Forest plots of standardized mean differences of IPSS scores of the included studies at three months (A), six months (B) and 12 months (C). L-TME laparoscopic total mesorectal excision; R-TME robotic total mesorectal excision; SD standard deviation; SMD standardised mean difference
Fig. 3
Fig. 3
Forest plots of standardized mean differences of IIEF scores of the included studies at three months (A), six months (B) and 12 months (C). L-TME laparoscopic total mesorectal excision; R-TME robotic total mesorectal excision; SD standard deviation; SMD standardised mean difference
See this image and copyright information in PMC

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