Short-term outcomes after total mesorectal excision for middle and low rectal cancer: transanal versus laparoscopic approach—a meta analysis

doi:10.16139/j.1007-9610.2022.05.011

Abstract

Abstract: Objective To compare the safety and efficacy of transanal total mesorectal excision (TaTME) and laparoscopic total mesorectal excision (LaTME) for middle and low rectal cancer. Methods This study searched the clinical studies systematically comparing the short-term efficacy of TaTME and LaTME published in PubMed, Web of Science, CNKI, China Biology Medicine disc and Wanfang medical database. Systematic reviews and meta-analysis were conducted to base on the Preferred Reporting Items for Systematic Evaluation and Meta-Analysis. Fixed-effects model or random-effects model was used for evaluation of data. Parameters of outcome evaluation included operation time, intraoperative blood loss, tumor size, conversion rate, length of hospital stay, number of lymph node dissection, distance of rectal lesion from anal verge, positive rate of distal resection margin(DRM), positive rate of circumferential resection margin(CRM), and postoperative complications. Results Nine studies with 1 of randomized controlled trial and 8 of prospective study were included to compare the outcomes of 451 TaTME and 438 LaTME in middle and low rectal cancer. TaTME had a significantly lower rate of conversion to open surgery (RR=0.13, P=0.002) and a lower DRM positive rate(RR=0.17, P<0.03) when compared to LaTME. There was no significant difference between two groups in operative time(RR=15.48, P=0.18), intraoperative blood loss (RR=2.34, P=0.81), postoperative complications (RR=1.05, P=0.72), length of hospital stay (RR=-0.91, P=0.14), tumor size (RR=0.04, P=0.55), number of lymph nodes dissection(RR=-0.71, P=0.17), distance of rectal lesion from anal verge(RR=-1.26, P=0.20) and positive rate of CRM(RR=0.77, P=0.53). Conclusions TaTME has the surgical safety same as LaTME. When the distal resection margin is at risk, TaTME may be a good choice for low and ultra-low rectal cancer.

Key words: Rectal cancer, Transanal total mesorectal excision, Laparoscopic total mesorectal excision, Meta-analysis

CLC Number:

R735.37

QIN Wei, HU Yanyan, XU Ximo, CAI Zhenghao, LI Jianwen, GONG Kunmei, FENG Bo. Short-term outcomes after total mesorectal excision for middle and low rectal cancer: transanal versus laparoscopic approach—a meta analysis[J]. Journal of Surgery Concepts & Practice, 2022, 27(05): 435-442.

Figures/Tables 5

References 25

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作者	年份	国家	研究类型	年龄（岁）		BMI（kg/m²）		文献质量评分（分）
作者	年份	国家	研究类型	TaTME	LaTME	TaTME	LaTME	文献质量评分（分）
顾永兴等^[24]	2019	中国	前瞻性	58.1±15.0	57.7±11.8	NA	NA	8
Li等^[16]	2021	中国	前瞻性	NA	NA	27.88±2.03	23.03±2.08	8
Di Candido等^[17]	2021	意大利	前瞻性	60.50±12.81	64.32±11.37	24.94±3.58	25.40±3.55	9
Ren等^[23]	2021	中国	前瞻性	65.78±12.37	67.16±10.03	22.87±2.66	23.05±2.70	8
Zuhdy等^[18]	2020	埃及	前瞻性	53.89±13.99	53.40±11.38	30.74±7.79	25.99±4.68	9
Zeng等^[19]	2020	中国	RCT	56.1±11.2	56.1±10.9	22.5±3.1	22.2±2.9	8
Rubinkiewicz等^[20]	2019	波兰	前瞻性	59.50±4.00	63.25±2.25	26.13±1.73	26.85±1.70	8
Sparreboom等^[21]	2019	荷兰	前瞻性	61.75±1.83	66.13±2.25	26.65±1.00	25.58±0.92	8
Roodbeen等^[22]	2019	荷兰	前瞻性	62.5±10.7	66.0±9.2	26.7±1.9	26.1±4.0	8