Abstract
Background
The aim of this study was to compare long-term oncological, functional outcomes and quality of life (QoL) after transanal total mesorectal excision (TaTME) and laparoscopic total mesorectal excision (LaTME) for rectal cancer.
Methods
A systematic review and meta-analysis based on Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were conducted on PubMed and Cochrane database. Non-randomized controlled trials (NRCTs) which compared TaTME with LaTME were included.
Results
Ten non-randomized studies were identified, including a total of 638 patients (323 TaTME and 315 LaTME). Age, sex, body mass index, neoadjuvant treatment and American Society of Anesthesiologists (ASA) staging of patients in the two groups were comparable in all included studies. The follow-up period was significantly shorter in the TaTME group than in the LaTME group. No significant differences in local (p = 0.71) and distant (p = 0.23) recurrence rate, 2-year disease-free (p = 0.86) and overall (p = 0.25) survival was found. Also, no significant differences in function outcomes and QoL, including the Wexner score (p = 0.48) or the International Prostate Syndrome Score (IPSS) (p = 0.64) were found. However, the low anterior resection syndrome (LARS) score was significantly higher in the TaTME group (p = 0.04).
Conclusions
TaTME and LaTME have similar long-term oncological and functional outcomes as well as QoL. The only exception is higher LARS scores after TaTME. The current data are based mainly on observational studies and further randomized controlled trials are required.
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References
Sylla P, Rattner DW, Delgado S, Lacy AM (2010) NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 24:1205–1210
Deijen CL, Velthuis S, Tsai A, Mavroveli S, de Lange-de Klerk ESM, Sietses C, Tuynman JB, Lacy AM, Hanna GB, Bonjer HJ (2016) COLOR III: a multicentre randomised clinical trial comparing transanal TME versus laparoscopic TME for mid and low rectal cancer. Surg Endosc 30:3210–3215
Lelong B, de Chaisemartin C, Meillat H, Cournier S, Boher JM, Genre D, Karoui M, Tuech JJ, Delpero JR (2017) A multicenter randomised controlled trial to evaluate the efficacy, morbidity and functional outcome of endoscopic transanal proctectomy versus laparoscopic proctectomy for low-lying rectal cancer (ETAP-GRECCAR 11 TRIAL): rationale and design. BMC Cancer 17:1–8
Zeng Z, Luo S, Chen J, Cai Y, Zhang X, Kang L (2019) Comparison of pathological outcomes after transanal versus laparoscopic total mesorectal excision: a prospective study using data from randomized control trial. Surg Endosc. https://doi.org/10.1007/s00464-019-07167-1,October4
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009) Preferred reporting items for systematic reviews and metaanalyses: the PRISMA statement. PLoS Med 62:1006–1012
Wells GA, Shea BJ, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P (2005) The Newcastle-Ottawa Scale (NOS) for assessing the quality of non-randomised studies in meta-analyses. Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa. Available from http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
Wan X, Wang W, Liu J, Tong T (2014) Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 14:1–13
Clarke M, Oxman AD (1999) Cochrane reviewers’ handbook 4.0. The Cochrane Collaboration, Oxford
Chen YT, Kiu KT, Yen MH, Chang TC (2019) Comparison of the shortterm outcomes in lower rectal cancer using three different surgical techniques: transanal total mesorectal excision (TME), laparoscopic TME, and open TME. Asian J Surg 42:674–680
Mege D, Hain E, Lakkis Z, Maggiori L, Prost a la Denise J, Panis Y, (2018) Is trans-anal total mesorectal excision really safe and better than laparoscopic total mesorectal excision with a perineal approach first in patients with low rectal cancer? A learning curve with case-matched study in 68 patients. Colorectal Dis 20:O143–O151
Veltcamp Helbach M, Koedam TWA, Knol JJ, Diederik A, Spaargaren GJ, Bonjer HJ, Tuynman JB, Sietses C (2019) Residual mesorectum on postoperative magnetic resonance imaging following transanal total mesorectal excision (TaTME) and laparoscopic total mesorectal excision (LapTME) in rectal cancer. Surg Endosc 33:94–102
Marks JH, Montenegro GA, Salem JF, Shields MV, Marks GJ (2016) Transanal TATA/TME: a case-matched study of taTME versus laparoscopic TME surgery for rectal cancer. Tech Coloproctol 20:467–473
Lelong B, Meillat H, Zemmour C, Poizat F, Ewald J, Mege D, Lelong JC, Delpero JR, de Chaisemartin C (2017) Short- and mid-term outcomes after endoscopic transanal or laparoscopictransabdominal total mesorectal excision for low rectal cancer: a single institutional case-control study. J Am Coll Surg 224:917–925
De’Angelis N, Portigliotti L, Azoulay D, Brunetti F (2015) Transanal total mesorectal excision for rectal cancer: a single center experience and systematic review of the literature. Langenbeck’s Arch Surg 400:945–959
Rubinkiewicz M, Zarzycki P, Witowski J, Pisarska M, Gajewska N, Torbicz G, Nowakowski M, Major P, Budzyński A, Pedziwiatr M (2019) Functional outcomes after resections for low rectal tumors: comparison of transanal with laparoscopic total mesorectal excision. BMC Surg 19:1–6
Bjoern MX, Perdawood SK (2020) Manometric assessment of anorectal function after transanal total mesorectal excision. Tech Coloproctol 24:231–236
Bjoern MX, Nielsen S, Perdawood SK (2019) Quality of life after surgery for rectal cancer: a comparison of functional outcomes after transanal and laparoscopic approaches. J Gastrointest Surg 23:1623–1630
Veltcamp Helbach M, Koedam TWA, Knol JJ, Velthuis S, Bonjer HJ, Tuynman JB, Sietses C (2018) Quality of life after rectal cancer surgery: differences between laparoscopic and transanal total mesorectal excision. Surg Endosc 33:79–87
Stevenson ARL, Solomon MJ, Lumley JW, Hewett P, Clouston AD, Gebski VJ, Davies L, Wilson K, Hague W, Simes J (2015) Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: the ALaCaRT randomized clinical trial. JAMA 314:1356–1363
Fleshman J, Branda M, Sargent DJ et al (2015) Effect of laparoscopic assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: the ACOSOG Z6051 randomized clinical trial. JAMA 314:1346–1355
Bonjer HJ, Deijen CL, Abis GA, Cuesta MA, van der Pas MHGM, de Lange-de Klerk ESM, Lacy AM, Bemelman WA, Andersson J, Angenete E, Rosenberg J, Fuerst A, Haglind E (2015) A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 372:1324–1332
Hompes R, Arnold S, Warusavitarne J (2014) Towards the safe introduction of transanal total mesorectal excision: the role of a clinical registry. Colorectal Dis 16:498–501
Sylla P, Bordeianou LG, Berger D, Han KS, Lauwers GY, Sahani DV, Sbeih MA, Lacy AM, Rattner DW (2013) A pilot study of natural orifice transanal endoscopic total mesorectal excision with laparoscopic assistance for rectal cancer. Surg Endosc 27:3396–3405
Heald RJ (2013) A new solution to some old problems: transanal TME. Tech Coloproctol 17:257–258
Nagtegaal ID, Marijnen CA, Kranenbarg EK, Van de Velde CJ, van Krieken JH, Committee PR, Investigators CC (2002) Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma: not one millimeter but two millimeters is the limit. Am J Surg Pathol 26:350–357
Adam IJ, Mohamdee MO, Martin IG, Scott N, Finan PJ, Johnston D, Dixon MF, Quirke P (1994) Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet 344:707–711
Rasulov AO, Dzhumabaev KE, Kozlov SYE, Mamedli ZZ, Kulushev VM, Gordeev SS, Kuzmichev DV, Polynovsky AV (2018) Transanal mesorectumectomy for rectal cancer—is it optimal surgery for ‘difficult’ patients? Khirurgiia (Mosk) 6:4–21
Aubert M, Mege D, Panis Y (2019) Total mesorectal excision for low and middle rectal cancer: laparoscopic versus transanal approach-a meta-analysis. Surg Endosc. https://doi.org/10.1007/s00464-019-07160-8,October15
Lin D, Yu Z, Chen W, Hu J, Huang X, He Z, Zou YF, Yu X, Guo X, Wu XJ (2019) Transanal versus laparoscopic total mesorectal excision for mid and low rectal cancer: a meta-analysis of short-term outcomes. Wideochir Inne Tech Maloinwazyjne 14:353–365
Zhang X, Gao Y, Dai X, Zhang H, Shang Z, Cai X, Shen T, Cheng X, Yu K, Li Y (2019) 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
Simillis C, Lal N, Thoukididou SN, Kontovounisios C, Smith JJ, Hompes R, Adamina M, Tekkis PP (2019) Open versus laparoscopic versus robotic versus transanal mesorectal excision for rectal cancer: a systematic review and network meta-analysis. Ann Surg 270:59–68
Kanso F, Maggiori L, Debove C, Chau A, Ferron M, Panis Y (2015) Perineal or abdominal approach first during intersphincteric resection for low rectal cancer: which is the best strategy? Dis Colon Rectum 58:637–644
Denost Q, Loughlin P, Chevalier R, Celerier B, Didailler R, Rullier E (2018) Transanal versus abdominal low rectal dissection for rectal cancer: long-term results of the Bordeaux’ randomized trial. Surg Endosc 32:1486–1494
Pontallier A, Denost Q, Van Geluwe B, Adam JP, Celerier B, Rullier E (2016) Potential sexual function improvement by using transanal mesorectal approach for laparoscopic low rectal cancer excision. Surg Endosc 30:4924–4933
Trenti L, Galvez A, Biondo S, Solis A, Vallribera-Valls F, Espin-Basany E, Garcia-Granero A, Kreisler E (2018) Quality of life and anterior resection syndrome after surgery for mid to low rectal cancer: a cross-sectional study. Eur J Surg Oncol 44:1031–1039
Chouillard E, Regnier A, Vitte RL, Bonnet BV, Greco V, Chahine E, Daher R, Biagini J (2016) Transanal NOTES total mesorectal excision (TME) in patients with rectal cancer: is anatomy better preserved? Tech Coloproctol 20:537–544
Foo CC, Kin Ng K, Tsang JS, Siu-Hung Lo O, Wei R, Yip J, Lun Law W (2020) Low anterior resection syndrome after transanal total mesorectal excision: a comparison with the conventional top-to-bottom approach. Dis Colon Rectum 63:497–503
Allaix ME, Rebecchi F, Giaccone C, MistrangeloMorino M (2011) Long-term functional results and quality of life after transanal endoscopic microsurgery. Br J Surg 98:1635–1643
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Drs. Iuliia Alimova, Stanislav Chernyshov, Marat Nagudov and Evgeniy Rybakov have no conflicts of interest or financial ties to disclose.
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Alimova, I., Chernyshov, S., Nagudov, M. et al. Comparison of oncological and functional outcomes and quality of life after transanal or laparoscopic total mesorectal excision for rectal cancer: a systematic review and meta-analysis. Tech Coloproctol 25, 901–913 (2021). https://doi.org/10.1007/s10151-021-02420-z
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DOI: https://doi.org/10.1007/s10151-021-02420-z