Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 3/2019

01-03-2019 | New Technology

Short- and long-term outcomes of transanal versus laparoscopic total mesorectal excision for mid-to-low rectal cancer: a meta-analysis

Authors: Xuan Zhang, Yi Gao, XingLong Dai, HongTao Zhang, ZhongJun Shang, XinYi Cai, Tao Shen, XianShuo Cheng, Kun Yu, YunFeng Li

Published in: Surgical Endoscopy | Issue 3/2019

Login to get access

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.
Literature
1.
2.
Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 69:613–616CrossRefPubMed
3.
Bonjer HJ, Deijen CL, Abis GA et al (2015) A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 372:1324–1332CrossRefPubMed
4.
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 15:767–774CrossRefPubMed
5.
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 97:1638–1645CrossRefPubMed
6.
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 14:210–218CrossRefPubMed
7.
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 27:1485–1502CrossRefPubMed
8.
Sylla P, Rattner DW, Delgado S et al (2010) NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 24:1205–1210CrossRefPubMed
9.
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 20:501–520CrossRefPubMed
10.
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 56:931CrossRefPubMed
11.
Atallah S, Albert M, Larach S (2010) Transanal minimally invasive surgery: a giant leap forward. Surg Endosc 24:2200–2205CrossRefPubMed
12.
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 19:221–229CrossRefPubMed
13.
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 20:1729–1734CrossRefPubMed
14.
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):1–12CrossRefPubMed
15.
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):603–605CrossRefPubMed
16.
17.
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):993–999CrossRefPubMed
18.
Velthuis S et al (2014) Transanal versus traditional laparoscopic total mesorectal excision for rectal carcinoma. Surg Endosc 28(12):3494–3499CrossRefPubMed
19.
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):637–644CrossRefPubMed
20.
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):945–959CrossRefPubMed
21.
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):1169–1176CrossRefPubMed
22.
Perdawood SK, AI KGA (2016) Transanal vs laparoscopic total mesorectal excision for rectal cancer: initial experience from Denmark. Colorectal Dis 18(1):51–58CrossRefPubMed
23.
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):221–227CrossRef
24.
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):467–473CrossRefPubMed
25.
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 20:537–544CrossRefPubMed
26.
Rasulov AO, Mamedli ZZ et al (2016) Short-term outcomes after transanal and laparoscopic total mesorectal excision for rectal cancer. Tech Coloproctol 20:227–234CrossRefPubMed
27.
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):917–925CrossRefPubMed
28.
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 12:575–582CrossRefPubMed
29.
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):1346–1355CrossRefPubMedPubMedCentral
30.
31.
Aigner F, Hörmann R, Fritsch H et al (2015) Anatomical considerations for transanal minimal-invasive surgery: the caudal to cephalic approach. Colorectal Dis 17:47–53CrossRef
32.
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 373:821–828CrossRefPubMedPubMedCentral
33.
34.
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 36:470–476CrossRefPubMed
35.
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 2:996–999CrossRefPubMed
36.
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):5248–5257CrossRefPubMed
37.
38.
Tuech JJ, Karoui M, Lelong B et al (2015) A step toward NOTES total mesorectal excision for rectal cancer: endoscopic transanal proctectomy. Ann Surg 261:228–233CrossRefPubMed
39.
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):321–325CrossRefPubMed
40.
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):415–423CrossRefPubMed
41.
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):5601–5614CrossRefPubMed
42.
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 95:199–205CrossRefPubMed
43.
Araujo SE, Crawshaw B et al (2015) Transanal total mesorectal excision: a systematic review of the experimental and clinical evidence. Tech Coloproctol 19:69–82CrossRefPubMed
44.
45.
Osoba D, Rodrigues G et al (1998) Interpreting the significance of changes in health-related quality-of- life scores. J Clin Oncol 16:139–144CrossRefPubMed
46.
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):25–33CrossRefPubMedPubMedCentral
47.
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 30:3210–3215CrossRefPubMed
48.
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 17:253CrossRefPubMedPubMedCentral
Metadata
Title
Short- and long-term outcomes of transanal versus laparoscopic total mesorectal excision for mid-to-low rectal cancer: a meta-analysis
Authors
Xuan Zhang
Yi Gao
XingLong Dai
HongTao Zhang
ZhongJun Shang
XinYi Cai
Tao Shen
XianShuo Cheng
Kun Yu
YunFeng Li
Publication date
01-03-2019
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 3/2019
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-018-6527-z

Other articles of this Issue 3/2019

Surgical Endoscopy 3/2019 Go to the issue

OriginalPaper

Laparoscopic pyloroplasty versus endoscopic per-oral pyloromyotomy for the treatment of gastroparesis

OriginalPaper

Digital single-operator cholangioscopy: a useful tool for selective guidewire placements across complex biliary strictures

OriginalPaper

Bile duct injuries (BDI) in the advanced laparoscopic cholecystectomy era

Dynamic Manuscript

Use of the Xi robotic platform for total abdominal colectomy: a step forward in minimally invasive colorectal surgery

2018 EAES Oral

Quality of life in patients with loco-regional rectal cancer after ELRR by TEM versus VLS TME after nChRT: long-term results

OriginalPaper

De novo gastroesophageal reflux disease after sleeve gastrectomy: role of preoperative silent reflux