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Published in: International Journal of Colorectal Disease 6/2021

01-06-2021 | Rectal Cancer | Review

Comparing functional outcomes between transanal total mesorectal excision (TaTME) and laparoscopic total mesorectal excision (LaTME) for rectal cancer: a systematic review and meta-analysis

Authors: Kay T. Choy, Tze Wei Wilson Yang, Swetha Prabhakaran, Alexander Heriot, Joseph C. Kong, Satish K Warrier

Published in: International Journal of Colorectal Disease | Issue 6/2021

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Abstract

Background

There is concern that transanal total mesorectal excision (TaTME) may result in poorer functional outcomes as compared to laparoscopic TME (LaTME). These concerns arise from the fact that TaTME entails both a low anastomosis and prolonged dilatation of the anal sphincter from the transanal platform.

Objectives

This paper aimed to assess the comparative functional outcomes following TaTME and LaTME, with a focus on anorectal and genitourinary outcomes.

Data sources

A meta-analysis and systematic review was performed on available literature between 2000 and 2020 from the PubMed, EMBASE, Medline, and Cochrane Library databases.

Study selection

All comparative studies assessing the functional outcomes following taTME versus LaTME in adults were included.

Main outcome measure

Functional anorectal and genitourinary outcomes were evaluated using validated scoring systems.

Results

A total of seven studies were included, consisting of one randomised controlled trial and six non-randomised studies. There were 242 (52.0%) and 233 (48.0%) patients in the TaTME and LaTME groups respectively. Anorectal functional outcomes were similar in both groups with regard to LARS scores (30.6 in the TaTME group and 28.3 in the LaTME group), Jorge-Wexner incontinence scores, and EORTC QLQ C30/29 scores. Genitourinary function was similar in both groups with IPSS scores of 5.5 to 8.0 in the TaTME group, and 3.5 to 10.1 in the LaTME group. (p = 0.835).

Conclusion

This review corroborates findings from previous studies in showing that the transanal approach is not associated with increased anal sphincter damage. Further prospective clinical trials are needed in this field of research.
Literature
1.
go back to reference Brouwer NP, Bos AC, Lemmens VE, Tanis PJ, Hugen N, Nagtegaal ID et al (2018) An overview of 25 years of incidence, treatment and outcome of colorectal cancer patients. Int J Cancer 143(11):2758–2766CrossRef Brouwer NP, Bos AC, Lemmens VE, Tanis PJ, Hugen N, Nagtegaal ID et al (2018) An overview of 25 years of incidence, treatment and outcome of colorectal cancer patients. Int J Cancer 143(11):2758–2766CrossRef
2.
go back to reference Bonjer HJ, Deijen CL, Abis GA, Cuesta MA, Van Der Pas MH, De Lange-De Klerk ES et al (2015) A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 372(14):1324–1332CrossRef Bonjer HJ, Deijen CL, Abis GA, Cuesta MA, Van Der Pas MH, De Lange-De Klerk ES et al (2015) A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 372(14):1324–1332CrossRef
3.
go back to reference Sylla P, Rattner DW, Delgado S, Lacy AM (2010) NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 24(5):1205–1210CrossRef Sylla P, Rattner DW, Delgado S, Lacy AM (2010) NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 24(5):1205–1210CrossRef
4.
go back to reference Keane C, Fearnhead NS, Bordeianou L, Christensen P, Espin Basany E, Laurberg S, Mellgren A, Messick C, Orangio GR, Verjee A, Wing K, Bissett I, the LARS International Collaborative Group, An V, Bryant A, Byrne C, Chen T, Clark D, Croft S, Dinning P, Gladman M, Heriot A, Kariappa S, Keck J, Lubowski D, Khera A, Kirkwood K, Petersen D, Sloots K, Totten B, Weston M, Andersen P, Bachmann C, Barht H, Emmertsen K, Faaborg P, Gögenur I, Ingerslev P, Isaksen D, Iversen H, Iversen L, Jacobsen K, Jansen T, Jocobsen I, Juul T, Kjær D, Krogh K, Majgaard M, Mynster A, Neuenschwander A, Nielsen C, Nielsen M, Nielsen R, Nielsen T, Olsen J, Poulsen B, Rahr H, Snedker B, Sørensen G, Stolzenburg T, Vaabengaard P, Acheson A, Andreyev J, Bach S, Battersby N, Bradbury J, Brown S, Cecil T, Chapman M, Chapman S, Chave H, Cook T, Cuffy L, Davies J, Dawson C, Dixon J, Duff S, Edwards C, Geh I, Hamilton C, Hancock L, Harji D, Hill J, Holtham S, Jenkins J, Johnston R, Kapur S, Maxwell-Armstrong C, McArthur D, Moran B, Norton C, Nugent K, Pateman L, Perston Y, Rockall T, Sagar P, Saunders M, Sebag-Montefiore D, Senapati A, Singh B, Skaife P, Smart N, Sykes H, Taylor C, Thorpe G, Tierney G, Voyce S, Walsh C, Warren O, Wheeler J, Woodward A, Winter D, Abbott S, Beban V, Bennett M, Chadwick T, Collinson R, Corbett S, Dennett E, Eglinton T, Fraser A, Glue J, Hohaia D, Menzi E, O’Connor M, Stevenson D, Wells C, Wolyncewicz S, Woodfield J, Bence K, Boutros M, Brueseke M, DeKorte J, Floruta C, Francone T, Frederick F, Grasso J, Gurland B, Higgins K, Hull T, Keller D, Laffan A, Lovett S, Marlatt J, McAdams D, McCarthy C, Milch H, Natale S, Pappou E, Paquette I, Pulskamp S, Rich M, Savitt L, Shafi M, Steele S, Stein S, Tolbert M, Varma M, Vogler S, Vuong T, Wells K, Wexner S, Wo J, Wright J, Wunderlich C, Campbell K, Lim M, Moug S, Oliphant R, Araujo-Ferreiro M, Ballester C, Belen-Bueno A, Blanco-Colino R, Carrillo-Moreno J, Castillo J, Codina-Cazador A, Enriquez-Navascuez JM, Gallego-García M, Jerez J, Jimenez LM, Labaka-Aretaga I, Martin-Fernández M, Martinez-Sanchez C, Muñoz A, Paniagua-Cayetano G, Pascual-Damieta M, de la Portilla F, Ramirez L, Sanchez-García C, Vaquer-Casas G, Vico-García E, Vigorita V, Adams R, Cornish J, Davies M, Evans M, Torkington J, Turner J (2020) International consensus definition of low anterior resection syndrome. Color Dis 22(3):331–341CrossRef Keane C, Fearnhead NS, Bordeianou L, Christensen P, Espin Basany E, Laurberg S, Mellgren A, Messick C, Orangio GR, Verjee A, Wing K, Bissett I, the LARS International Collaborative Group, An V, Bryant A, Byrne C, Chen T, Clark D, Croft S, Dinning P, Gladman M, Heriot A, Kariappa S, Keck J, Lubowski D, Khera A, Kirkwood K, Petersen D, Sloots K, Totten B, Weston M, Andersen P, Bachmann C, Barht H, Emmertsen K, Faaborg P, Gögenur I, Ingerslev P, Isaksen D, Iversen H, Iversen L, Jacobsen K, Jansen T, Jocobsen I, Juul T, Kjær D, Krogh K, Majgaard M, Mynster A, Neuenschwander A, Nielsen C, Nielsen M, Nielsen R, Nielsen T, Olsen J, Poulsen B, Rahr H, Snedker B, Sørensen G, Stolzenburg T, Vaabengaard P, Acheson A, Andreyev J, Bach S, Battersby N, Bradbury J, Brown S, Cecil T, Chapman M, Chapman S, Chave H, Cook T, Cuffy L, Davies J, Dawson C, Dixon J, Duff S, Edwards C, Geh I, Hamilton C, Hancock L, Harji D, Hill J, Holtham S, Jenkins J, Johnston R, Kapur S, Maxwell-Armstrong C, McArthur D, Moran B, Norton C, Nugent K, Pateman L, Perston Y, Rockall T, Sagar P, Saunders M, Sebag-Montefiore D, Senapati A, Singh B, Skaife P, Smart N, Sykes H, Taylor C, Thorpe G, Tierney G, Voyce S, Walsh C, Warren O, Wheeler J, Woodward A, Winter D, Abbott S, Beban V, Bennett M, Chadwick T, Collinson R, Corbett S, Dennett E, Eglinton T, Fraser A, Glue J, Hohaia D, Menzi E, O’Connor M, Stevenson D, Wells C, Wolyncewicz S, Woodfield J, Bence K, Boutros M, Brueseke M, DeKorte J, Floruta C, Francone T, Frederick F, Grasso J, Gurland B, Higgins K, Hull T, Keller D, Laffan A, Lovett S, Marlatt J, McAdams D, McCarthy C, Milch H, Natale S, Pappou E, Paquette I, Pulskamp S, Rich M, Savitt L, Shafi M, Steele S, Stein S, Tolbert M, Varma M, Vogler S, Vuong T, Wells K, Wexner S, Wo J, Wright J, Wunderlich C, Campbell K, Lim M, Moug S, Oliphant R, Araujo-Ferreiro M, Ballester C, Belen-Bueno A, Blanco-Colino R, Carrillo-Moreno J, Castillo J, Codina-Cazador A, Enriquez-Navascuez JM, Gallego-García M, Jerez J, Jimenez LM, Labaka-Aretaga I, Martin-Fernández M, Martinez-Sanchez C, Muñoz A, Paniagua-Cayetano G, Pascual-Damieta M, de la Portilla F, Ramirez L, Sanchez-García C, Vaquer-Casas G, Vico-García E, Vigorita V, Adams R, Cornish J, Davies M, Evans M, Torkington J, Turner J (2020) International consensus definition of low anterior resection syndrome. Color Dis 22(3):331–341CrossRef
5.
go back to reference Koedam T, Van Ramshorst G, Deijen C, Elfrink A, Meijerink W, Bonjer H et al (2017) Transanal total mesorectal excision (TaTME) for rectal cancer: effects on patient-reported quality of life and functional outcome. Techniques in coloproctology 21(1):25–33CrossRef Koedam T, Van Ramshorst G, Deijen C, Elfrink A, Meijerink W, Bonjer H et al (2017) Transanal total mesorectal excision (TaTME) for rectal cancer: effects on patient-reported quality of life and functional outcome. Techniques in coloproctology 21(1):25–33CrossRef
6.
go back to reference Andersson J, Abis G, Gellerstedt M, Angenete E, Angerås U, Cuesta M et al (2014) Patient-reported genitourinary dysfunction after laparoscopic and open rectal cancer surgery in a randomized trial (COLOR II). Br J Surg 101(10):1272–1279CrossRef Andersson J, Abis G, Gellerstedt M, Angenete E, Angerås U, Cuesta M et al (2014) Patient-reported genitourinary dysfunction after laparoscopic and open rectal cancer surgery in a randomized trial (COLOR II). Br J Surg 101(10):1272–1279CrossRef
7.
go back to reference Roodbeen SX, Penna M, Mackenzie H, Kusters M, Slater A, Jones OM, Lindsey I, Guy RJ, Cunningham C, Hompes R (2019) Transanal total mesorectal excision (TaTME) versus laparoscopic TME for MRI-defined low rectal cancer: a propensity score-matched analysis of oncological outcomes. Surg Endosc 33(8):2459–2467CrossRef Roodbeen SX, Penna M, Mackenzie H, Kusters M, Slater A, Jones OM, Lindsey I, Guy RJ, Cunningham C, Hompes R (2019) Transanal total mesorectal excision (TaTME) versus laparoscopic TME for MRI-defined low rectal cancer: a propensity score-matched analysis of oncological outcomes. Surg Endosc 33(8):2459–2467CrossRef
8.
go back to reference Foo CC, Kin Ng K, Tsang JS, Siu-hung Lo O, Wei R, Yip J, Lun Law W (2020) Low anterior resection syndrome after transanal total mesorectal excision: a comparison with the conventional top-to-bottom approach. Dis Colon Rectum 63(4):497–503CrossRef Foo CC, Kin Ng K, Tsang JS, Siu-hung Lo O, Wei R, Yip J, Lun Law W (2020) Low anterior resection syndrome after transanal total mesorectal excision: a comparison with the conventional top-to-bottom approach. Dis Colon Rectum 63(4):497–503CrossRef
9.
go back to reference Bjoern MX, Nielsen S, Perdawood SK (2019) Quality of life after surgery for rectal Cancer: a comparison of functional outcomes after Transanal and laparoscopic approaches. J Gastrointest Surg 23(8):1623–1630CrossRef Bjoern MX, Nielsen S, Perdawood SK (2019) Quality of life after surgery for rectal Cancer: a comparison of functional outcomes after Transanal and laparoscopic approaches. J Gastrointest Surg 23(8):1623–1630CrossRef
10.
go back to reference Rubinkiewicz M, Zarzycki P, Witowski J, Pisarska M, Gajewska N, Torbicz G, Nowakowski M, Major P, Budzyński A, Pędziwiatr M (2019) Functional outcomes after resections for low rectal tumors: comparison of Transanal with laparoscopic Total Mesorectal excision. BMC Surg 19(1):79CrossRef Rubinkiewicz M, Zarzycki P, Witowski J, Pisarska M, Gajewska N, Torbicz G, Nowakowski M, Major P, Budzyński A, Pędziwiatr M (2019) Functional outcomes after resections for low rectal tumors: comparison of Transanal with laparoscopic Total Mesorectal excision. BMC Surg 19(1):79CrossRef
11.
go back to reference Dou R (2019) SunW, Luo S, Hou Y, Zhang C, Kang L. comparison of postoperative bowel function between patients undergoing transanal and laparoscopic total mesorectal excision. Zhonghua Wei Chang Wai Ke Za Zhi 22:246–254PubMed Dou R (2019) SunW, Luo S, Hou Y, Zhang C, Kang L. comparison of postoperative bowel function between patients undergoing transanal and laparoscopic total mesorectal excision. Zhonghua Wei Chang Wai Ke Za Zhi 22:246–254PubMed
12.
go back to reference Mora L, Zarate A, Serra-Aracil X, Pallisera A, Serra S, Navarro-Soto S (2018) Afectación funcional y calidad de vida tras cirugía de cáncer rectal [Functional impairment and quality of life after rectal cancer surgery]. Cir Cir 86(2):140–147PubMed Mora L, Zarate A, Serra-Aracil X, Pallisera A, Serra S, Navarro-Soto S (2018) Afectación funcional y calidad de vida tras cirugía de cáncer rectal [Functional impairment and quality of life after rectal cancer surgery]. Cir Cir 86(2):140–147PubMed
13.
go back to reference Veltcamp Helbach M, Koedam TWA, Knol JJ, Velthuis S, Bonjer HJ, Tuynman JB, Sietses C (2019) Quality of life after rectal cancer surgery: differences between laparoscopic and transanal total mesorectal excision. Surg Endosc 33(1):79–87CrossRef Veltcamp Helbach M, Koedam TWA, Knol JJ, Velthuis S, Bonjer HJ, Tuynman JB, Sietses C (2019) Quality of life after rectal cancer surgery: differences between laparoscopic and transanal total mesorectal excision. Surg Endosc 33(1):79–87CrossRef
14.
go back to reference Pontallier A, Denost Q, Van Geluwe B, Adam JP, Celerier B, Rullier E (2016) Potential sexual function improvement by using transanal mesorectal approach for laparoscopic low rectal cancer excision. Surg Endosc 30(11):4924–4933CrossRef Pontallier A, Denost Q, Van Geluwe B, Adam JP, Celerier B, Rullier E (2016) Potential sexual function improvement by using transanal mesorectal approach for laparoscopic low rectal cancer excision. Surg Endosc 30(11):4924–4933CrossRef
15.
go back to reference Rouanet P, Mourregot A, Azar CC, Carrere S, Gutowski M, Quenet F, Saint-Aubert B, Colombo PE (2013) Transanal endoscopic proctectomy: an innovative procedure for difficult resection of rectal tumors in men with narrow pelvis. Dis Colon Rectum 56(4):408–415CrossRef Rouanet P, Mourregot A, Azar CC, Carrere S, Gutowski M, Quenet F, Saint-Aubert B, Colombo PE (2013) Transanal endoscopic proctectomy: an innovative procedure for difficult resection of rectal tumors in men with narrow pelvis. Dis Colon Rectum 56(4):408–415CrossRef
16.
go back to reference Kang L, Sylla P, Atallah S, Ito M, Wexner SD, Wang J-P. taTME: boom or bust? : Oxford University Press; 2020 Kang L, Sylla P, Atallah S, Ito M, Wexner SD, Wang J-P. taTME: boom or bust? : Oxford University Press; 2020
17.
go back to reference Van der Heijden J, Koëter T, Smits L, Sietses C, Tuynman J, Maaskant-Braat A et al (2020) Functional complaints and quality of life after transanal total mesorectal excision: a meta-analysis. Br J Surg 107(5):489–498CrossRef Van der Heijden J, Koëter T, Smits L, Sietses C, Tuynman J, Maaskant-Braat A et al (2020) Functional complaints and quality of life after transanal total mesorectal excision: a meta-analysis. Br J Surg 107(5):489–498CrossRef
18.
go back to reference Juul T, Ahlberg M, Biondo S, Emmertsen KJ, Espin E, Jimenez LM, Matzel KE, Palmer G, Sauermann A, Trenti L, Zhang W, Laurberg S, Christensen P (2014) International validation of the low anterior resection syndrome score. Ann Surg 259(4):728–734CrossRef Juul T, Ahlberg M, Biondo S, Emmertsen KJ, Espin E, Jimenez LM, Matzel KE, Palmer G, Sauermann A, Trenti L, Zhang W, Laurberg S, Christensen P (2014) International validation of the low anterior resection syndrome score. Ann Surg 259(4):728–734CrossRef
19.
go back to reference Chen TY-T, Emmertsen KJ, Laurberg S (2015) What are the best questionnaires to capture anorectal function after surgery in rectal cancer? Current colorectal cancer reports 11(1):37–43CrossRef Chen TY-T, Emmertsen KJ, Laurberg S (2015) What are the best questionnaires to capture anorectal function after surgery in rectal cancer? Current colorectal cancer reports 11(1):37–43CrossRef
20.
go back to reference Tuech J-J, Karoui M, Lelong B, De Chaisemartin C, Bridoux V, Manceau G et al (2015) A step toward NOTES total mesorectal excision for rectal cancer: endoscopic transanal proctectomy. Ann Surg 261(2):228–233CrossRef Tuech J-J, Karoui M, Lelong B, De Chaisemartin C, Bridoux V, Manceau G et al (2015) A step toward NOTES total mesorectal excision for rectal cancer: endoscopic transanal proctectomy. Ann Surg 261(2):228–233CrossRef
21.
go back to reference Ribas Y, Aguilar F, Jovell-Fernández E, Cayetano L, Navarro-Luna A, Muñoz-Duyos A (2017) Clinical application of the LARS score: results from a pilot study. Int J Color Dis 32(3):409–418CrossRef Ribas Y, Aguilar F, Jovell-Fernández E, Cayetano L, Navarro-Luna A, Muñoz-Duyos A (2017) Clinical application of the LARS score: results from a pilot study. Int J Color Dis 32(3):409–418CrossRef
22.
go back to reference O'Connor R (2004) Measuring quality of life in health. Measuring quality of life in health. p. xvi, 264-xvi, O'Connor R (2004) Measuring quality of life in health. Measuring quality of life in health. p. xvi, 264-xvi,
Metadata
Title
Comparing functional outcomes between transanal total mesorectal excision (TaTME) and laparoscopic total mesorectal excision (LaTME) for rectal cancer: a systematic review and meta-analysis
Authors
Kay T. Choy
Tze Wei Wilson Yang
Swetha Prabhakaran
Alexander Heriot
Joseph C. Kong
Satish K Warrier
Publication date
01-06-2021
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Colorectal Disease / Issue 6/2021
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-021-03849-2

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