Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2022; 14(12): 1397-1410
Published online Dec 27, 2022. doi: 10.4240/wjgs.v14.i12.1397
Meta-analysis of transanal vs laparoscopic total mesorectal excision of low rectal cancer: Importance of appropriate patient selection
Pratik Bhattacharya, Ishaan Patel, Noureen Fazili, Shahab Hajibandeh, Shahin Hajibandeh
Pratik Bhattacharya, Department of Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham B71 4HJ, United Kingdom
Ishaan Patel, Noureen Fazili, Department of Surgery, Queen Elizabeth Hospital Birmingham, Birmingham B15 2GW, United Kingdom
Shahab Hajibandeh, Department of Surgery, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
Shahin Hajibandeh, Department of Surgery, Royal Stoke University Hospital, Stoke-on-Trent ST4 6QG, United Kingdom
Author contributions: Shahi H designed the research study; Patel I, Bhattacharya P, and Fazili N collected the data for the meta-analysis; Hajibandeh S and Hajibandeh S analysed and interpreted the data, did the statistical analysis, and wrote the article; all authors critically revised the article and provided final approval for the article.
Conflict-of-interest statement: There are no conflicts of interest to report.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Shahin Hajibandeh, MD, Senior Researcher, Surgeon, Department of Surgery, Royal Stoke University Hospital, Newcastle Road, Stoke-on-Trent ST4 6QG, United Kingdom.
Received: October 2, 2022
Peer-review started: October 2, 2022
First decision: October 30, 2022
Revised: November 6, 2022
Accepted: December 13, 2022
Article in press: December 13, 2022
Published online: December 27, 2022
Research background

Achieving a clear resection margins for low rectal cancer is technically challenging. Transanal TME (TaTME) has been introduced in order to address the chalenges associated with the open and laparoscopic TME (LaTME) in resecting low rectal tumours.

Research motivation

Previous meta-analyses have included mixed patients with mid and low rectal tumours when comparing TaTME and LaTME which has made the interpretation of the real differences between two approaches in treating low rectal cancer difficult.

Research objectives

To investigate the outcomes of transanal TaTME and LaTME in patients with low rectal cancer.

Research methods

A comprehensive systematic review of comparative studies were conducted according to the standards of Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Intraoperative and postoperative complications, anastomotic leak, completeness of mesorectal excision, R0 resection, distal (DRM) and circumferential resection margin (CRM), number of harvested lymph nodes, and procedure time were the evaluated outcome parameters.

Research results

We identified twelve comparative studies enrolling a total of 969 patients comparing the outcomes of TaTME (n = 969) and LaTME (n = 476) in patients with low rectal cancer. The meta-analysis demonstrated that TaTME was associated with significantly lower rate of postoperative complications (OR: 0.74, P = 0.04), anastomotic leak (OR: 0.59, P = 0.02), and conversion to an open procedure (OR: 0.29, P = 0.002) compared with LaTME. Moreover, it was associated with significantly higher rate of R0 resection (OR: 1.96, P = 0.03). However, there was no significant difference in intraoperative complications (OR: 1.87; P = 0.23), completeness of mesoractal excision (OR: 1.57, P = 0.15), harvested lymph nodes (MD: -0.05, P = 0.96), DRM (MD: -0.94; P = 0.17), CRM (MD: 1.08, P = 0.17), positive CRM (OR: 0.64, P = 0.11) and procedure time (MD: -6.99 minutes, P = 0.45) between TaTME and LaTME.

Research conclusions

Our findings indicated that for low rectal tumours, TaTME is associated with better clinical and short term oncological outcomes compared to LaTME.

Research perspectives

The available evidence does not allow evaluation of long term oncological and functional outcomes. More randomized controlled trials are required to confirm the findings of this meta-analysis regarding clinical and short term oncological outcomes and to evaluate long term oncological and functional outcomes.