Abstract
BackgroundTotal 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.MethodsA 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.ResultsA 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.ConclusionNo differences in function were observed between transanal and laparoscopic TME.
Highlights
Total mesorectal excision (TME) is the standard surgical treatment for rectal cancer, with excellent long-term local recurrence-free and overall survival rates1
P values are shown for transanal TME (TaTME) versus laparoscopic TME (LapTME)
The present review investigated the impact of TaTME on functional outcomes and quality of life (QoL)
Summary
Total mesorectal excision (TME) gives excellent oncological results in rectal cancer treatment, but patients may experience functional problems. This systematic review evaluated the functional outcomes and quality of life after transanal and laparoscopic TME. 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). Conclusion: No differences in function were observed between transanal and laparoscopic TME. Paper accepted 3 February 2020 Published online 10 March 2020 in Wiley Online Library (www.bjs.co.uk).
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