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Transanal total mesorectal excision versus laparoscopic intersphincteric resection for low rectal cancer: a propensity score matching analysis

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Abstract

Background

Anus-preserving surgery for low rectal cancer has always been a serious difficulty for surgeons. Transanal total mesorectal excision (TaTME) and laparoscopic intersphincteric resection (ISR) are commonly used Anus-preserving surgeries for low rectal cancer. The aim of this study was to compare the clinical use of two surgical methods.

Methods

A total of 152 patients with low rectal cancer were treated with taTME in 75 cases and ISR in 77 cases. After propensity score matching, 46 patients in each group were included in the study. Perioperative outcomes, anal function scores (Wexner incontinence score) and quality of life scores (EORTC QLQ C30, EORTC QLQ CR38) at least 1 year after surgery were compared between the two groups.

Results

There were no significant differences between the two groups in terms of surgical outcomes, pathological examination of surgical specimens, postoperative recovery, and postoperative complications, except for patients in the taTME group who had their indwelling catheters removed later. Anal Wexner incontinence score was lower in taTME group than ISR group (P < 0.05). On the EORTC QLQ-C30 scale, the physical function and role function scores in the ISR group were lower than those in the taTME group (P < 0.05), while the fatigue, pain symptoms, and constipation scores in the ISR group were higher than those in the taTME group (P < 0.05). On the EORTC QLQ-CR38 scale, the scores of gastrointestinal symptoms and defecation problems in the ISR group were higher than those in the taTME group (P < 0.05).

Conclusion

Compared with ISR surgery, taTME surgery is comparable in terms of surgical safety and short-term efficacy, and has better long-term anal function and quality of life. From the perspective of long-term anal function and quality of life, taTME surgery is a better surgical method for the treatment of low rectal cancer.

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Funding

Science and Technology Foundation Project of Guizhou Health Commission (Grant No. gzwkj2023-154).

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Author notes

  1. Zhengbiao Li and·Qi Wang have contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi, China

    Zhengbiao Li, Qi Wang, Weiwei Ning, Qinxu Yang, Yong Huang, Shuai Yan, Bo Yang & Ming Xie

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  1. Zhengbiao Li
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  2. Qi Wang
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Correspondence to Ming Xie.

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All authors (Zhengbiao Li, M.M., Qi Wang, M.M., Weiwei Ning, M.M., Qinxu Yang, M.M., Yong Huang, M.M., Shuai Yan, M.M., Bo Yang, M.M., Ming Xie, Prof.,) have no conflicts of interest or financial ties to disclose.

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Li, Z., Wang, Q., Ning, W. et al. Transanal total mesorectal excision versus laparoscopic intersphincteric resection for low rectal cancer: a propensity score matching analysis. Surg Endosc 37, 6852–6860 (2023). https://doi.org/10.1007/s00464-023-10090-1

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