Clinical outcomes and case volume effect of transanal total mesorectal excision for rectal cancer: a systematic review

Abstract

Transanal total mesorectal excision (TaTME) has been developed to improve quality of TME for patients with mid and low rectal cancer. However, despite enthusiastic uptake and teaching facilities, concern exists for safe introduction. TaTME is a complex procedure and potentially a learning curve will hamper clinical outcome. With this systematic review, we aim to provide data regarding morbidity and safety of TaTME. A systematic literature search was performed in MEDLINE (PubMed), EMBASE (Ovid) and Cochrane Library. Case reports, cohort series and comparative series on TaTME for rectal cancer were included. To evaluate a potential effect of case volume, low-volume centres (n ≤ 30 total volume) were compared with high-volume centres (n > 30 total volume). Thirty-three studies were identified (three case reports, 25 case series, five comparative studies), including 794 patients. Conversion was performed in 3.0% of the procedures. The complication rate was 40.3, and 11.5% were major complications. The quality of the mesorectum was “complete” in 87.6%, and the circumferential resection margin (CRM) was involved in 4.7%. In low- versus high-volume centres, the conversion rate was 4.3 versus 2.7%, and major complication rates were 12.2 versus 10.5%, respectively. TME quality was “complete” in 80.5 versus 89.7%, and CRM involvement was 4.8 and 4.5% in low- versus high-volume centres, respectively. TaTME for mid and low rectal cancer is a promising technique; however, it is associated with considerable morbidity. Safe implementation of the TaTME should include proctoring and quality assurance preferably within a trial setting.

Short-term outcomes of transanal completion total mesorectal excision (cTaTME) for rectal cancer: a case-matched analysis

“…Decreasing this risk from 20% in an earlier study and 28% in our cTME group to 4% in our cTaTME group seems very promising [2]. These outcomes are comparable to previous published results of primary radical rectal surgery [22][23][24]. Completion TME is also associated with higher colostomy rate compared to primary TME (51 vs. 46%, OR 2.5; 95% CI 1.30-4.86) [1,3,4].…”

Results of transanal mesorectumectomy in patients with rectal cancer

“…Несмотря на то, что начало промежностного этапа связано с внутри-просветными манипуляциями с последующим выходом в полость малого таза, методика Та-ТМЭ не увеличи-вает количество послеоперационных гнойно-септиче-ских осложнений в сравнении с традиционной Лап-ТМЭ, что подтверждается данными других авторов [11].…”

“…Новым подходом явилась трансанальная мезорек-тумэктомия (Та-ТМЭ), подразумевающая мобилиза-цию прямой кишки в нижне-или среднеампулярном отделе «снизу вверх», под непосредственным визуаль-ным контролем хирурга [8][9][10][11]. Оценке результатов применения данной хирургической технологии и по-священа настоящая статья.…”

Új távlatok a végbélrák sebészetében: Transanalis teljes mesorectum excisio. Kezdeti eredményeink

“…Jelenleg négy metaanalízis összegzi a mintegy 40 esetleírást, esetkontroll-tanulmányt és esetsorozatot ismertető klinikai tanulmányt a TaTME vonatkozásában [22,[30][31][32].…”