Meta-analysis of transanal total mesorectal excision versus laparoscopic total mesorectal excision in management of rectal cancer

Hajibandeh, Shahin; Hajibandeh, Shahab; Eltair, Mokhtar; George, Anil Thomas; Thumbe, V.; Torrance, Andrew W.; Budhoo, Misra; Joy, Howard; Peravali, Rajeev

doi:10.1007/s00384-020-03545-7

Cited by 35 publications

(27 citation statements)

References 37 publications

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“…This compares favourably to the literature with rates of complete TME of between 92.7 and 97.5% [5,26]. Meta-analysis comparing laparoscopic TME to TaTME supports these findings with significantly higher rates of R0 resection (OR 1.67, p = 0.001) and lower rates of positive CRM (OR 0.67, p = 0.04) with the use of TaTME [13]. At a median follow-up of 15 months (IQR 9-31 months) we report a local recurrence rate of 6%, occurring at a median of 18 months (IQR 13-25 months); this is comparable to the reported outcomes for laparoscopic TME.…”

Section: Discussionsupporting

confidence: 76%

Oncological outcomes and stoma-free survival following TaTME, a prospective cohort study

et al. 2021

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Background Transanal TME (TaTME) was introduced to improve access to the pelvis in difficult cases (male sex, obesity and mid to low rectal cancers) and reduce the risk of anastomotic leak by avoiding cross stapling. In April 2018 the Norwegian hospital to whom all local; recurrences for rectal cancer are referred reported an unexpected rise in early multifocal local recurrences of 9.5% following TaTME compared with 3.4% following conventional TME leading to a nationwide moratorium on the procedure and ending, in an editorial published on the British Journal of Surgery in August 2020, by saying that other countries should consider the issue in the context of local practices and results. There are limited data concerning oncological outcomes of TaTME compared to conventional TME. The aim of this study was to report perioperative and oncological outcomes for patients with rectal cancer treated with TaTME in a high-volume, experienced UK centre. Methods From January 2015 to January 2020 consecutive patients with histologically confirmed rectal cancer having TaTME at Worcestershire Royal Hospital NHS were prospectively entered into an online international registry. Patients were followed according to local protocol with clinical examination, tumour markers, endoscopy and radiology. Results Seventy patients underwent TaTME for rectal cancer. The median distance of the tumour from the anorectal junction was 4 cm (IQR 2-5). The mesorectal margin was involved in 20 (1%) patients, all of whom received neoadjuvant chemoradiotherapy. Overall survival was 94% at a median follow-up of 15 months (IQR 9-31 months). Distant recurrence occurred in 12 (17%) of patients at a median of 14 months (IQR 10-17 months). The 18-month stoma-free survival rate was 66%. Conclusions A local recurrence rate of 5.7% supports the oncological safety of TaTME for rectal cancer.

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Section: Discussionsupporting

confidence: 76%

Oncological outcomes and stoma-free survival following TaTME, a prospective cohort study

et al. 2021

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“…Meanwhile, a 2020 meta-analysis of 17 studies found no significant difference in postoperative complications between the taTME and laTME groups (34.7 vs. 36.3%). 24 The most frequent complications were urethral injury and other urologic injuries. Sylla et al 25 recently reported 34 urethral, two ureteral, and three bladder injuries after TaTME surgery operated by 32 surgical teams within a 7-year study period.…”

Section: Postoperative Complications and Anastomotic Leakagementioning

confidence: 99%

“…This resulted in the main complications of urethral injury, nerve injury, and bleeding. Meanwhile, a 2020 meta‐analysis of 17 studies found no significant difference in postoperative complications between the taTME and laTME groups (34.7 vs. 36.3%) 24 . The most frequent complications were urethral injury and other urologic injuries.…”

Section: Consensusmentioning

confidence: 99%

Controversies and consensus in transanal total mesorectal excision (taTME): Is it a valid choice for rectal cancer?

Jiang

2021

Journal of Surgical Oncology

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Transanal total mesorectal excision (taTME) is a novel approach to radical surgery for low rectal cancer. taTME is associated with the benefits of a higher rate of free distal resection margins (DRM) under direct visualization, better visualization of the mesorectal plane, and the feasibility of overcoming the restriction of the distal pelvis. Thus, it is increasingly used globally. In this review, we investigated whether taTME yields better short-and long-term outcomes than laparoscopic TME.

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“…OpS vs LaS, LaS vs RoS, and LaS vs TaTME, have been reported in RCTs, meta-analyses, and reviews. [33][34][35][36][37][38][39][40][41] These comparisons were performed between LaS and other approaches because LaS was the first type of minimally invasive surgery and was initially compared with conventional OpS, followed by RoS and TaTME, which were subsequently developed as different types of minimally invasive surgery. On the other hand, in actual clinical practice, few medical institutions or surgeons perform all four approaches, or even three of the approaches, on a routine basis, and thus it is difficult to conduct an RCT that compares three or four of the approaches at once.…”

Section: Introductionmentioning

confidence: 99%

“…Regarding the four surgical approaches for rectal cancer, many comparisons between two techniques, e.g. OpS vs LaS, LaS vs RoS, and LaS vs TaTME, have been reported in RCTs, meta‐analyses, and reviews 33‐41 . These comparisons were performed between LaS and other approaches because LaS was the first type of minimally invasive surgery and was initially compared with conventional OpS, followed by RoS and TaTME, which were subsequently developed as different types of minimally invasive surgery.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the perioperative outcomes of laparoscopic surgery, robotic surgery, open surgery, and transanal total mesorectal excision for rectal cancer: An overview of systematic reviews

Yamamoto

2020

Annals of Gastroent Surgery

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Regarding the surgical approaches for rectal cancer, many techniques have been reported in randomized controlled trials, meta‐analyses, and reviews of comparisons between two techniques, e.g. open surgery vs laparoscopic surgery, laparoscopic surgery vs robotic surgery, or laparoscopic surgery vs transanal total mesorectal excision. Since robotic surgery and transanal total mesorectal excision were developed after laparoscopic surgery had become an established minimally invasive technique, they have each been compared with laparoscopic surgery. Therefore, a review was performed to compare the surgical outcomes of robotic surgery and transanal total mesorectal excision, and to perform such comparisons among ≥3 of the above mentioned approaches, in the expectation that this review will serve as a reference for aiding treatment selection in future. The results of the current review suggest that all of the examined procedures have advantages and disadvantages, but that there are no decisive factors that could be used to select one procedure over any other. At the present time it cannot be demonstrated that laparoscopic surgery, robotic surgery, transanal total mesorectal excision, or open surgery is superior to the other techniques, and it is important to select the best technique for each patient from among those that a surgeon can perform. It is also important to maintain a flexible attitude that allows new techniques to be adopted as needed in the future.

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Meta-analysis of transanal total mesorectal excision versus laparoscopic total mesorectal excision in management of rectal cancer

Cited by 35 publications

References 37 publications

Oncological outcomes and stoma-free survival following TaTME, a prospective cohort study

Oncological outcomes and stoma-free survival following TaTME, a prospective cohort study

Controversies and consensus in transanal total mesorectal excision (taTME): Is it a valid choice for rectal cancer?

Comparison of the perioperative outcomes of laparoscopic surgery, robotic surgery, open surgery, and transanal total mesorectal excision for rectal cancer: An overview of systematic reviews

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