Abstract
Background and objectives
Transanal total mesorectal excision (TaTME) is positioned at the cutting edge of minimally invasive approach to mid- and low rectal cancer. This meta-analysis was to compare the short- and long-term outcomes of TaTME versus laparoscopic total mesorectal excision (LTME) and to evaluate the safety, efficacy, and possible superiority of TaTME.
Methods
A comprehensive search was conducted for randomized controlled trials (RCTs) and non-RCTs (NRCTs) comparing TaTME with LTME. Inter-group differences were evaluated via standardized mean differences and relative risks (RRs). All outcomes were analyzed using fixed effects or random effects models according to the heterogeneity. Statistical analysis was performed using Stata/SE 12.0 software.
Results
Eleven studies (1 RCT and 10 NRCTs) with involving 757 patients were included. Among which, 361 patients underwent TaTME and 396 patients underwent LTME. Comparing the surgical and oncological quality of resection of TaTME with that of LTME, reports of TaTME indicated favorable outcomes considering mesorectal resection quality, circumferential resection margin involvement, intraoperative blood loss, conversions, and postoperative complications, while the differences between the two groups had no statistical significance in terms of distal resection margin, harvested lymph node, operation time, hospital stay, recurrence, 2-year overall survival (OS), and 2-year disease-free survival.
Conclusion
TaTME is a promising surgical technique and is fully a safe, efficacious, and diffusible alternative to LTME in managing mid- and distal rectal cancer. Larger scale, national, multicentric RCTs are warranted to further verify these results and the possible superiority of TaTME.
Similar content being viewed by others
References
Siegel RL, Miller KD, Jemal A (2017) Cancer statistics, 2017. CA Cancer J Clin 67(1):7–30
Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 69:613–616
Bonjer HJ, Deijen CL, Abis GA et al (2015) A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 372:1324–1332
Jeong SY, Park JW, Nam BH et al (2014) Open versus laparoscopic surgery for mid-rectal or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol 15:767–774
Jayne DG, Thorpe HC, Copeland J et al (2010) Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 97:1638–1645
van der Pas MH, Haglind E et al (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14:210–218
Arezzo A, Passera R, Scozzari G et al (2013) Laparoscopy for rectal cancer reduces short-term mortality and morbidity: results of a systematic review and meta-analysis. Surg Endosc 27:1485–1502
Sylla P, Rattner DW, Delgado S et al (2010) NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 24:1205–1210
Marks JH, Frenkel JL, D’Andrea AP et al (2011) Maximizing rectal cancer results: TEM and TATA techniques to expand sphincter preservation. Surg Oncol Clin N Am 20:501–520
Atallah SB, Larach S, deBeche-Adams TC et al (2013) Transanal minimally invasive surgery (TAMIS): a technique that can be used for retrograde proctectomy. Dis Colon Rectum 56:931
Atallah S, Albert M, Larach S (2010) Transanal minimally invasive surgery: a giant leap forward. Surg Endosc 24:2200–2205
Knol J, D’Hondt M, Souverijns G et al (2015) Transanal endoscopic total mesorectal excision: technical aspects of approaching the mesorectal plane from below—a preliminary report. Tech Coloproctol 19:221–229
Nagtegaal ID, van de Velde CJ, van der Worp E et al (2002) Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol 20:1729–1734
Jadad AR, Moore RA, Carroll D et al (1996) Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clin Trials 17(1):1–12
Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25(9):603–605
Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539
Denost Q et al (2014) Perineal transanal approach a new standard for laparoscopic sphincter-saving resection in low rectal cancer, a randomized trial. Ann Surg 260(6):993–999
Velthuis S et al (2014) Transanal versus traditional laparoscopic total mesorectal excision for rectal carcinoma. Surg Endosc 28(12):3494–3499
Kanso F et al (2015) Perineal RR abdominal approach first during intersphincteric resection for low rectal cancer: which is the best strategy? Dis Colon Rectum 58(7):637–644
de’Angelis N et al (2015) Transanal total mesorectal excision for rectal cancer: a single center experience and systematic review of the literature. Langenbecks Arch Surg 400(8):945–959
Chen CC, Lai YL et al (2016) Transanal total mesorectal excision versus laparoscopic surgery for rectal cancer receiving neoadjuvant chemoradiation: a matched case–control study. Ann Surg Oncol 23(4):1169–1176
Perdawood SK, AI KGA (2016) Transanal vs laparoscopic total mesorectal excision for rectal cancer: initial experience from Denmark. Colorectal Dis 18(1):51–58
Fern´andez-Hevia M et al (2015) Transanal total mesorectal excision in rectal cancer short-term outcomes in comparison with laparoscopic surgery. Ann Surg 261(2):221–227
Marks JH et al (2016) Transanal TATA/TME: a case-matched study of taTME versus laparoscopic TME surgery for rectal cancer. Tech Coloproctol 20(7):467–473
Chouillard E, Regnier A et al (2016) Transanal NOTES total mesorectal excision (TME) in lower rectal with rectal cancer: Is anatomy better preserved? Tech Coloproctol 20:537–544
Rasulov AO, Mamedli ZZ et al (2016) Short-term outcomes after transanal and laparoscopic total mesorectal excision for rectal cancer. Tech Coloproctol 20:227–234
Lelong B, Meillat H, Zemmour C et al (2017) Short- and mid-term outcomes after endoscopic transanal or laparoscopic transabdominal total mesorectal excision for low rectal cancer: a single institutional case-control study. J Am Coll Surg 224(5):917–925
van Gijn W, Marijnen CA, Nagtegaal ID et al (2011) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol 12:575–582
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(13):1346–1355
Heald RJ (2013) A new solution to some old problems: transanal TME. Tech Coloproctol 17:257–258
Aigner F, Hörmann R, Fritsch H et al (2015) Anatomical considerations for transanal minimal-invasive surgery: the caudal to cephalic approach. Colorectal Dis 17:47–53
Quirke P, Steele R, Monson J et al (2009) Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 and randomised clinical trial. Lancet 373:821–828
Lichliter WE (2015) Techniques in total mesorectal excision surgery. Clin Colon Rectal Surg 28:21–27
Kusters M, Marijnen CA, van de Velde CJ et al (2010) Patterns of local recurrence in rectal cancer; a study of the Dutch TME trial. Eur J Surg Oncol 36:470–476
Quirke P, Durdey P, Dixon MF et al (1986) Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet 2:996–999
Marks JH, Myers EA, Zeger EL et al (2017) Long-term outcomes by a transanal approach to total mesorectal excision for rectal cancer. Surg Endosc 31(12):5248–5257
Penna M, Cunningham C, Hompes R (2017) Transanal total mesorectal excision: Why, When, and How. Clin Colon Rectal Surg 30:339–345
Tuech JJ, Karoui M, Lelong B et al (2015) A step toward NOTES total mesorectal excision for rectal cancer: endoscopic transanal proctectomy. Ann Surg 261:228–233
Atallah S, Albert M, DeBeche-Adams T et al (2013) Transanal minimally invasive surgery for total mesorectal excision (TAMIS-TME): a stepwise description of the surgical technique with video demonstration. Tech Coloproctol 17(3):321–325
Lacy AM, Tasende MM, Delgado S et al (2015) Transanal total mesorectal excision for rectal cancer: outcomes after 140 patients. J Am Coll Surg 221(2):415–423
Zhang X, Wei Z, Bie M et al (2016) Robot-assisted versus laparoscopic-assisted surgery for colorectal cancer: a meta-analysis. Surg Endosc 30(12):5601–5614
Thorpe H, Jayne DG, Guillou PJ et al (2008) Patient factors influencing conversion from laparoscopically assisted to open surgery for colorectal cancer. Br J Surg 95:199–205
Araujo SE, Crawshaw B et al (2015) Transanal total mesorectal excision: a systematic review of the experimental and clinical evidence. Tech Coloproctol 19:69–82
Suwanabol PA, Maykel JA (2017) Transanal total mesorectal excision: a novel approach to rectal surgery. Clin Colon Rectal Surg 30:120–129
Osoba D, Rodrigues G et al (1998) Interpreting the significance of changes in health-related quality-of- life scores. J Clin Oncol 16:139–144
Koedam TW, Van Ramshorst GH et al (2017) Transanal total mesorectal excision (TaTME) for rectal cancer: effects on patient-reported quality of life and functional outcome. Tech Coloproctol 21(1):25–33
Deijen CL, Velthuis S, Tsai A et al (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 et al (2017) A multicentre 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 17:253
Author information
Authors and Affiliations
Contributions
XZ and YG conceived and designed the study. ZJS and XYC researched literature and extracted the data. XZ, XLD, HTZ, KY, and TS participated in analysis, manuscript drafting, and editing. XSC and YFL revised the study.
Corresponding author
Ethics declarations
Disclosures
Xuan Zhang, Yi Gao, **ngLong Dai, HongTao Zhang, ZhongJun Shang, **nYi Cai, Tao Shen, **anShuo Cheng, Kun Yu, and YunFeng Li have declared that no conflicts of interest or financial ties to disclose.
Rights and permissions
About this article
Cite this article
Zhang, X., Gao, Y., Dai, X. et al. 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 (2019). https://doi.org/10.1007/s00464-018-6527-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-018-6527-z