Abstract
BackgroundTransanal total mesorectal excision (taTME) is an emerging surgical technique for rectal cancer. However, the oncological and perioperative outcomes are controversial when compared with conventional laparoscopic total mesorectal excision (laTME).MethodsA systematic review and meta-analysis based on Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was conducted in PubMed, Embase and Cochrane database. All original studies published in English that compared taTME with laTME were included for critical appraisal and meta-analysis. Data synthesis and statistical analysis were carried out using RevMan 5.3 software.ResultsA total of seven studies including 573 patients (taTME group = 270; laTME group = 303) were included in our meta-analysis. Concerning the oncological outcomes, no differences were observed in harvested lymph nodes, distal resection margin (DRM) and positive DRM between the two groups. However, the taTME group showed a higher rate of achievement of complete grading of mesorectal quality (OR = 1.75, 95% CI = 1.02–3.01, P = 0.04), a longer circumferential resection margin (CRM) and less involvement of positive CRM (CRM: WMD = 0.96, 95% CI = 0.60–1.31, P <0.01; positive CRM: OR = 0.39, 95% CI = 0.17–0.86, P = 0.02). Concerning the perioperative outcomes, the results for hospital stay, intraoperative complications and readmission were comparable between the two groups. However, the taTME group showed shorter operation times (WMD = –23.45, 95% CI = –37.43 to –9.46, P <0.01), a lower rate of conversion (OR = 0.29, 95% CI = 0.11–0.81, P = 0.02) and a higher rate of mobilization of the splenic flexure (OR = 2.34, 95% CI = 0.99–5.54, P = 0.05). Although the incidence of anastomotic leakage, ileus and urinary morbidity showed no difference between the groups, a significantly lower rate of overall postoperative complications (OR = 0.65, 95% CI = 0.45–0.95, P = 0.03) was observed in the taTME group.ConclusionsIn comparison with laTME, taTME seems to achieve comparable technical success with acceptable oncologic and perioperative outcomes. However, multicenter randomized controlled trials are required to further evaluate the efficacy and safety of taTME.
Highlights
Transanal total mesorectal excision is an emerging surgical technique for rectal cancer
The utility of laparoscopic total mesorectal excision (laTME) is limited in patients with low rectal cancer, who require surgeons with experience in ultra-low sphincter-saving laparoscopic surgery, which has a high risk of leaving a positive circumferential resection margin (CRM)
One report described a protocol for a multicenter randomized clinical trials (RCTs) comparing transanal total mesorectal excision (TME) and laTME for midand low-rectal cancer [25]
Summary
Search strategy This systematic review and meta-analysis were conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines (http://www.prisma-statement.org/) [17]. The MeSH and main keywords were as follows: “transanal”, “transanal total mesorectal excision” or “taTME”, “transanal minimally invasive surgery” or “TAMIS”, “transanal endoscopic microsurgery” or “TEM”, “natural orifice transluminal endoscopic surgery” or “NOTES”, “perineal approach”, “rectal cancer” and “proctectomy” Based on these MesH and main keywords, we formulated the search strategy (for PubMed) as following: (transanal OR transanal minimally invasive surgery OR TAMIS OR transanal endoscopic microsurgery OR TEM OR transanal specimen extraction OR natural orifice specimen extraction OR NOSE OR natural orifice transluminal endoscopic surgery OR NOTES OR peritoneal) AND (total mesorectal excision OR TME OR proctectomy) AND rectal. A Cochrane Q statistical P value 50% was taken to indicate significant heterogeneity, and in this case a randomeffects model was used for the pooled analysis [20, 21]. All the statistical analyses were performed using software from the Cochrane Collaboration (RevMan v5.3; Nordic Cochrane Centre)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
