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Comparing perioperative and oncological outcomes of transanal and laparoscopic total mesorectal excision for rectal cancer: a meta-analysis of randomized controlled trials and prospective studies

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Abstract

Introduction

Meta-analysis of the results of transanal total mesorectal excision (taTME) and laparoscopic TME (laTME) regarding perioperative and oncological outcomes have been conducted. Due to the lack of high-quality randomized controlled trials (RCTs) and prospective studies in the included literature, the conclusions are unreliable. This study included RCTs and prospective studies for analysis to obtain more reliable conclusions.

Materials and methods

Systematic searches of the PubMed, Embase, and Cochrane Library databases were conducted up to June 2023. To assess the quality, the Cochrane quality assessment tool and the Newcastle–Ottawa Scale were employed. The perioperative and oncological outcomes were then analyzed. The I2 statistic was used to evaluate statistical heterogeneity and sensitivity analyses was conducted.

Results

A total of 22 studies, comprising 5056 patients, were included in the analysis, of which 6 were RCTs and 16 were prospective studies. The conversion rate in the taTME group was significantly lower than that in the laTME group (OR 0.14, 95% CI 0.09 to 0.22, P < 0.01), and the circumferential resection margin (CRM) was longer (MD 0.99 mm, 95% CI 0.66 to 1.32 mm, P < 0.01), with a lower rate of positive CRM involvement (OR 0.68, 95% CI 0.47 to 0.97, P = 0.03). No statistically significant differences were found in terms of the operation time, intraoperative blood loss, complications, anastomotic leakage, uroschesis, obstruction, secondary operation, hospital stay, urethral injury, readmission, mortality rate within 30 days, mesorectal resection quality, number of harvested lymph nodes, distal resection margin (DRM), positive DRM, local recurrence, and distance recurrence (P > 0.05).

Conclusion

According to the findings of this meta-analysis, which is based on RCTs and prospective studies, taTME appears to have an advantage over laTME in terms of conversion rate and CRM involvement.

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Data availability

With the publication, the data set used for this meta-analysis will be shared upon request from the study authors.

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Acknowledgements

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Funding

This work was supported by the Clinical Medical Technology Innovation Guidance Project of Hunan Provincial Science and Technology Department (No. 2018SK51609) and the Natural Science Foundation of Hunan Province (No. 2021JJ70118).

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, The First Affiliated Hospital of the University of South China, Hengyang, 421001, Hunan, China

    Xianhao Yi & Jun Ouyang

  2. Department of Stomatology, The First Affiliated Hospital of the University of South China, Hengyang, 421001, Hunan, China

    Xuan Zhang

  3. Department of Radiology, The First Affiliated Hospital of the University of South China, Hengyang, 421001, Hunan, China

    Qingchun Li

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  1. Xianhao Yi
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Contributions

Study concepts and design: XY, JO. Literature search: XY, XZ. Data extraction: XY, XZ, QL. Data analysis: XY, XZ. Manuscript preparation: XY, XZ. Critical revision: JO. All authors have participated sufficiently in the study and approved the final version.

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Correspondence to Jun Ouyang.

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Xianhao Yi, Xuan Zhang, Qingchun Li, Jun Ouyang have no conflicts of interest or financial ties to disclose.

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Supplementary Information

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464_2023_10495_MOESM1_ESM.tiff

Supplementary file1 (TIFF 211 kb) Figure S1. Risk of bias in randomized controlled trials sutdies. (A) Risks of bias across all included randomized controlled trials, (B) summary of risks of bias for the different domains.

464_2023_10495_MOESM2_ESM.tiff

Supplementary file2 (TIFF 548 kb) Figure S2. Sensitivity analysis by omitt single study. (A) operation time, (B) intraoperative blood loss, (C) complications.

464_2023_10495_MOESM3_ESM.tiff

Supplementary file3 (TIFF 431 kb) Figure S3. Sensitivity analysis by omitt single study. (A) hospital stay, (B) readmission.

464_2023_10495_MOESM4_ESM.tiff

Supplementary file4 (TIFF 386 kb) Figure S4. Funnel plots and Egger’s test. (A) operation time, (B) intraoperative blood loss, (C) conversion, (D) complications, (E) anastomotic leakage, (F) uroschesis, (G) obstruction, (H) secondary operation, (I) hospital stay, (J) urethral injury.

464_2023_10495_MOESM5_ESM.tiff

Supplementary file5 (TIFF 387 kb) Figure S5. Funnel plots and Egger’s test. (A) readmission, (B) mortality rate within 30 days, (C) mesorectal resection quality, (D) number of harvested lymph nodes, (E) DRM, (F) positive DRM, (G) CRM, (H) positive CRM, (I) local recurrence, (J) distance recurrence.

Supplementary file6 (DOCX 17 kb)

Supplementary file7 (DOCX 39 kb)

Supplementary file8 (DOCX 18 kb)

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Yi, X., Zhang, X., Li, Q. et al. Comparing perioperative and oncological outcomes of transanal and laparoscopic total mesorectal excision for rectal cancer: a meta-analysis of randomized controlled trials and prospective studies. Surg Endosc 37, 9228–9243 (2023). https://doi.org/10.1007/s00464-023-10495-y

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