Meta-analysis of transanal vs laparoscopic total mesorectal excision of low rectal cancer: Importance of appropriate patient selection

Comparing efficacy and safety of transanal vs. laparoscopic total mesorectal excision for middle and low rectal cancer: Updated meta-analysis

OBJECTIVE

This study aimed to compare the efficacy and safety of transanal total mesorectal excision (TaTME) with laparoscopic total mesorectal excision (LaTME) in patients with middle and low rectal cancer.

METHODS

A comprehensive search of PubMed, Embase, and Cochrane databases was conducted to identify studies evaluating TaTME and LaTME from inception to June 2023. An additional search update was conducted in November 2024 to capture recently published studies. A total of 24 studies (3 randomized controlled trials and 21 observational studies) involving 3443 patients were included. Meta-analysis assessed key outcomes, including circumferential resection margin (CRM) positivity, R0 resection rate, completeness of mesorectal excision, conversion to open surgery, and postoperative complications.

RESULTS

TaTME was associated with a significantly lower positive rate of CRM (odds ratio [OR] = 0.68, 95 % confidence interval [CI] = 0.49-0.94), a higher R0 resection rate (OR = 1.74, 95 % CI = 1.17-2.59), and a reduced incidence of conversion to open surgery (OR = 0.16, 95 % CI = 0.10-0.26) compared to LaTME. Completeness of ME was comparable between the two groups (OR = 1.29, 95 % CI = 0.85-1.96). There was no significant difference in postoperative complications (OR = 0.80, 95 % CI = 0.62-1.03) or 30-day mortality (OR = 0.42, 95 % CI = 0.12-1.47).

CONCLUSIONS

TaTME demonstrates superior outcomes in terms of CRM positivity, R0 resection, and conversion rates compared to LaTME, with comparable safety profiles and no significant differences in postoperative complications or 30-day mortality. These findings support TaTME as a viable surgical approach for middle and low rectal cancer.

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

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.