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Short- and long-term outcomes of transanal versus laparoscopic total mesorectal excision for mid-to-low rectal cancer: a meta-analysis

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Abstract

Background and objectives

Transanal total mesorectal excision (TaTME) is positioned at the cutting edge of minimally invasive approach to mid- and low rectal cancer. This meta-analysis was to compare the short- and long-term outcomes of TaTME versus laparoscopic total mesorectal excision (LTME) and to evaluate the safety, efficacy, and possible superiority of TaTME.

Methods

A comprehensive search was conducted for randomized controlled trials (RCTs) and non-RCTs (NRCTs) comparing TaTME with LTME. Inter-group differences were evaluated via standardized mean differences and relative risks (RRs). All outcomes were analyzed using fixed effects or random effects models according to the heterogeneity. Statistical analysis was performed using Stata/SE 12.0 software.

Results

Eleven studies (1 RCT and 10 NRCTs) with involving 757 patients were included. Among which, 361 patients underwent TaTME and 396 patients underwent LTME. Comparing the surgical and oncological quality of resection of TaTME with that of LTME, reports of TaTME indicated favorable outcomes considering mesorectal resection quality, circumferential resection margin involvement, intraoperative blood loss, conversions, and postoperative complications, while the differences between the two groups had no statistical significance in terms of distal resection margin, harvested lymph node, operation time, hospital stay, recurrence, 2-year overall survival (OS), and 2-year disease-free survival.

Conclusion

TaTME is a promising surgical technique and is fully a safe, efficacious, and diffusible alternative to LTME in managing mid- and distal rectal cancer. Larger scale, national, multicentric RCTs are warranted to further verify these results and the possible superiority of TaTME.

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Authors and Affiliations

  1. Department of Colorectal Cancer Surgery, Clinical Research Center of Colorectal Cancer, Tumor Hospital of Yun Nan Province, The Third Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China

    Xuan Zhang, Yi Gao, HongTao Zhang, XinYi Cai, Tao Shen, XianShuo Cheng, Kun Yu & YunFeng Li

  2. Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China

    XingLong Dai

  3. Department of Hospital Affairs Management, Tumor Hospital of Yun Nan Province, The Third Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China

    ZhongJun Shang

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  1. Xuan Zhang
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Contributions

XZ and YG conceived and designed the study. ZJS and XYC researched literature and extracted the data. XZ, XLD, HTZ, KY, and TS participated in analysis, manuscript drafting, and editing. XSC and YFL revised the study.

Corresponding author

Correspondence to YunFeng Li.

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Disclosures

Xuan Zhang, Yi Gao, XingLong Dai, HongTao Zhang, ZhongJun Shang, XinYi Cai, Tao Shen, XianShuo Cheng, Kun Yu, and YunFeng Li have declared that no conflicts of interest or financial ties to disclose.

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Zhang, X., Gao, Y., Dai, X. et al. Short- and long-term outcomes of transanal versus laparoscopic total mesorectal excision for mid-to-low rectal cancer: a meta-analysis. Surg Endosc 33, 972–985 (2019). https://doi.org/10.1007/s00464-018-6527-z

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