Comparison of transanal total mesorectal excision and laparoscopic total mesorectal excision for rectal cancer

Abstract

Objective To analyze the efficacy and prognosis of transanal total mesorectal excision (TaTME) and laparoscopic total mesorectal excision (LaTME) in the treatment of middle and lower rectal cancer. Methods From February 2015 to February 2016, sixty-four patients with moderate to low rectal cancer undergoing elective TME were selected and randomly divided into two groups: TaTME group and LaTME group, with 32 cases in each group. The following indexes such as the operation time, intraoperative blood loss, specimen integrity rate, circumferential resection margin (CRM) positive rate, distal resection margin (DRM) negative rate, lymph node dissection, retention rate, conversion rate, intraoperative complications, postoperative complications, postoperative hospital stay, local recurrence rate, distant metastasis rate, and 2-year overall survival rate (OS) were compared between the two groups. Results The intraoperative bleeding, operation time, postoperative hospital stay, and rate of conversion, specimen integrity, positive CRM, anal preservation, urinary retention in TaTME group were significantly better than those in LaTME group (all P<0.05). All patients were followed up for 2-24 months. The median survival time was 23.9 months in TaTME group and 19.7 months in LaTME group. There were no significant differences between the two groups in the local recurrence rate and metastasis rate (6.2% vs 3.1%, χ2=0.350, P=0.554; 3.1% vs 3.1%, χ2=0.516, P=0.472). The local recurrence rate and metastasis rate were 6.2% (2/32) and 3.1%(1/32), respectively. No significant difference was found between the two groups in the 1 year OS (100.00% vs 93.75%, χ2=0.516, P=0.472). The 2-year OS of TaTME group was significantly higher than that of LaTME group (96.87% vs 81.25%, χ2=4.402, P=0.036). Conclusion Compared with LaTME, TaTME has the advantages of less postoperative complications, shorter postoperative hospital stay and better prognosis, and is safe and feasible in the treatment of middle and lower rectal cancer. Key words: Rectal neoplasms; Total mesorectal excision; Transanal; Laparoscopes