Comparison of oncological and functional outcomes and quality of life after transanal or laparoscopic total mesorectal excision for rectal cancer: a systematic review and meta-analysis

Alimova, Yu.V.; Чернышов, С. В.; Нагудов, М. А.; Rybakov, E. G.

doi:10.1007/s10151-021-02420-z

Cited by 23 publications

(17 citation statements)

References 33 publications

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“…According to literature, 19 to 52% of patients who underwent sphincter preserving rectal surgery for cancer experience an altered defecation status known as LARS syndrome [7,8,14,16,23,24]. The results of the present series disclosed that our patients could be ranked in the best-performing groups, with 13.4% of minor LARS and 25.8% of major LARS after TaTME, in support of the bene ts the transanal approach can offer.…”

Section: Discussionsupporting

confidence: 72%

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Anorectal functional outcomes after transanal total mesorectal excision (TaTME): a Random Forest analysis to predict patients' outcomes

Tirelli

Lorenzon

Biondi

et al. 2022

Preprint

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Background. Anorectal, sexual and urinary dysfunctions are still common issues after rectal cancer surgery, although seldom explored. Objective. To investigate the entire spectrum of anorectal urinary, and sexual functional outcomes in patients treated with trans-anal total mesorectal excision (TaTME). Design. Patients with a mid-/low-rectal cancer (1-11 cm from the anorectal junction) treated with TaTME between 2015-2020, were interviewed after surgery using validated questionnaires. Statistical analyses were computed to identify variables correlated with worse outcomes and to provide a decision tree algorithm. Setting. University Research Hospital, high volume referral center for rectal cancer surgery. Patients. Patients were included if undergoing TaTME with primary anastomosis with or without diverting ileostomy/colostomy. Only patients with a minimum follow-up of 6 months (from stoma reversal or from the primary procedure) were selected. Interventions. Patients were interviewed using the CCFIS - Wexner Scale, LARS score, ICIQ-MLUTS, ICIQ-FLUTS, IIEF and FSFI questionnaires. Main Outcome Measures. The primary outcome measure was the bowel function. Secondary outcomes were urinary and sexual functional data. Results. Out of 154 patients treated with TaTME, 97 were included (mean age: 66.1 years, M/F 1.7). Sixty-seven percent underwent NAD and 88.7% had a protective stoma. Patients were interviewed in a mean time of 19.0±9.3 months after primary or stoma reversal surgery. Mean Wexner score was 3.8±4.8, whereas mean LARS score was 17.4±13.8. Statistical analyses documented that increased age, operative time and interval to stoma reversal correlated with worse Wexner-LARS categories. The Random Forest analyses documented worse LARS symptoms among patients with an operative time>295 minutes and a stoma reversal performed after more than 5.6 months. Among those who carried a stoma from 3-5.6 months, patients older than 65 years reported anorectal postoperative dysfunction. Limitations. Single center experience with no comparison group. Conclusions. TaTME can provide good long-term results for the anorectal functions. An algorithm with specific risk categories was provided to identify sub-groups at risk to develop major LARS syndrome.

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Section: Discussionsupporting

confidence: 72%

“…Despite many concerns related to the use of the transanal platform, with the consequent anal stretching, prolonged dilatation and risk of sphincter damage [8, 16, 28], different systematic reviews [7,8,24] reported that laparoscopic TME and TaTME offer similar results in terms of functional outcomes.…”

Section: Discussionmentioning

confidence: 99%

Anorectal functional outcomes after transanal total mesorectal excision (TaTME): a Random Forest analysis to predict patients' outcomes

Tirelli

Lorenzon

Biondi

et al. 2022

Preprint

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“…Previous experiences of MIS and transanal surgery and formatted instructions for taTME are critical factors that make a difference (25,47). Although there is currently a lack of high-level evidence, the latest meta-analysis (48,49) still stands for the noninferiority of taTME. Argument also increased the quality of life and functional outcomes of patients after taTME.…”

Section: The Controversy Of Tatmementioning

confidence: 99%

Clinical Status and Future Prospects of Transanal Total Mesorectal Excision

Guo

Wang

et al. 2022

Front. Oncol.

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Low rectal cancer has always posed surgical challenges to gastrointestinal surgeons. Transanal total mesorectal excision (taTME) is a novel approach to radical resection for low rectal cancer. Compared with conventional laparoscopic TME (laTME), taTME is relevant to the benefits of better vision of the mesorectal plane, feasibility of operating in a narrow pelvis, and exact definition of distal resection margin, which may lead to a higher possibility of free circumferential resection margin, better quality of TME specimen, and lower conversion rate. Although there are concerns about its long-term oncological outcomes and complex learning curve, taTME is a promising alternative for rectal cancer. In this review, we discuss the application status and prospects of taTME.

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“…The potential postoperative urinary dysfunction and poor bowel function after TaTME could affect the QoL beyond the oncologic benefits and should be discussed with the patient in the preoperative setting [ 66 ]. In this matter, 2 recent meta-analyses have compared functional anorectal and urologic outcomes between TaTME and LapTME [ 67 , 68 ]; both studies did not find significant differences regarding urologic outcomes (International Prostate Syndrome Scores of 5.5 to 8.0 in the TaTME group, and 3.5 to 10.1 in the LapTME group) and anorectal functional outcomes were similar in both groups with concerning low anterior resection syndrome (LARS) scores but significantly higher in the TaTME group. In the long term, both techniques have similar oncological and functional outcomes and QoL.…”

Section: Surgical Managementmentioning

confidence: 99%

Surgical Treatment of Low-Lying Rectal Cancer: Updates

Varela

Kim

2021

Ann Coloproctol

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Despite innovative advancements, distally located rectal cancer remains a critical disease of challenging management. The crucial location of the tumor predisposes it to a circumferential resection margin (CRM) that tends to involve the anal sphincter complex and surrounding organs, with a high incidence of delayed anastomotic complications and the risk of the pelvic sidewall or rarely inguinal lymph node metastases. In this regard, colorectal surgeons should be aware of other issues beyond total mesorectal excision (TME) performance. For decades, the concept of extralevator abdominoperineal resection to avoid compromised CRM has been introduced. However, the complexity of deep pelvic dissection with poor visualization in low-lying rectal cancer has led to transanal TME. In contrast, neoadjuvant chemoradiotherapy (NCRT) has allowed for the execution of more sphincter-saving procedures without oncologic compromise. Significant tumor regression after NCRT and complete pathologic response also permit applying the watch-and-wait protocol in some cases, now with more solid evidence. This review article will introduce the current surgical treatment options, their indication and technical details, and recent oncologic and functional outcomes. Lastly, the novel characteristics of distal rectal cancer, such as pelvic sidewall and inguinal lymph node metastases, will be discussed along with its tailored and individualized treatment approach.

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Comparison of oncological and functional outcomes and quality of life after transanal or laparoscopic total mesorectal excision for rectal cancer: a systematic review and meta-analysis

Cited by 23 publications

References 33 publications

Anorectal functional outcomes after transanal total mesorectal excision (TaTME): a Random Forest analysis to predict patients' outcomes

Anorectal functional outcomes after transanal total mesorectal excision (TaTME): a Random Forest analysis to predict patients' outcomes

Clinical Status and Future Prospects of Transanal Total Mesorectal Excision

Surgical Treatment of Low-Lying Rectal Cancer: Updates

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