Controversies and consensus in transanal total mesorectal excision (taTME): Is it a valid choice for rectal cancer?

Jiang, Tianyu; Ma, Junjun

doi:10.1002/jso.26340

Cited by 8 publications

(4 citation statements)

References 37 publications

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“…As TaTME has reported more and more in recent years, so has its controversy ( 52 ). The main focus is on whether TaTME can get better safety and efficacy with mid to low-rectal cancer in patients.…”

Section: Discussionmentioning

confidence: 99%

A systematic review and meta-analysis of minimally invasive total mesorectal excision versus transanal total mesorectal excision for mid and low rectal cancer

杜刚¹,

Lin²,

Zhang³

et al. 2023

Front. Oncol.

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BackgroundMinimally invasive total mesorectal excision (MiTME) and transanal total mesorectal excision (TaTME) are popular trends in mid and low rectal cancer. However, there is currently no systematic comparison between MiTME and TaTME of mid and low-rectal cancer. Therefore, we systematically study the perioperative and pathological outcomes of MiTME and TaTME in mid and low rectal cancer.MethodsWe have searched the Embase, Cochrane Library, PubMed, Medline, and Web of Science for articles on MiTME (robotic or laparoscopic total mesorectal excision) and TaTME (transanal total mesorectal excision). We calculated pooled standard mean difference (SMD), relative risk (RR), and 95% confidence intervals (CIs). The protocol for this review has been registered on PROSPERO (CRD42022374141).ResultsThere are 11010 patients including 39 articles. Compared with TaTME, patients who underwent MiTME had no statistical difference in operation time (SMD -0.14; CI -0.31 to 0.33; I2=84.7%, P=0.116), estimated blood loss (SMD 0.05; CI -0.05 to 0.14; I2=48%, P=0.338), postoperative hospital stay (RR 0.08; CI -0.07 to 0.22; I2=0%, P=0.308), over complications (RR 0.98; CI 0.88 to 1.08; I2=25.4%, P=0.644), intraoperative complications (RR 0.94; CI 0.69 to 1.29; I2=31.1%, P=0.712), postoperative complications (RR 0.98; CI 0.87 to 1.11; I2=16.1%, P=0.789), anastomotic stenosis (RR 0.85; CI 0.73 to 0.98; I2=7.4%, P=0.564), wound infection (RR 1.08; CI 0.65 to 1.81; I2=1.9%, P=0.755), circumferential resection margin (RR 1.10; CI 0.91 to 1.34; I2=0%, P=0.322), distal resection margin (RR 1.49; CI 0.73 to 3.05; I2=0%, P=0.272), major low anterior resection syndrome (RR 0.93; CI 0.79 to 1.10; I2=0%, P=0.386), lymph node yield (SMD 0.06; CI -0.04 to 0.17; I2=39.6%, P=0.249), 2-year DFS rate (RR 0.99; CI 0.88 to 1.11; I2=0%, P = 0.816), 2-year OS rate (RR 1.00; CI 0.90 to 1.11; I2=0%, P = 0.969), distant metastasis rate (RR 0.47; CI 0.17 to 1.29; I2=0%, P = 0.143), and local recurrence rate (RR 1.49; CI 0.75 to 2.97; I2=0%, P = 0.250). However, patients who underwent MiTME had fewer anastomotic leak rates (SMD -0.38; CI -0.59 to -0.17; I2=19.0%, P<0.0001).ConclusionThis study comprehensively and systematically evaluated the safety and efficacy of MiTME and TaTME in the treatment of mid to low-rectal cancer through meta-analysis. There is no difference between the two except for patients with MiTME who have a lower anastomotic leakage rate, which provides some evidence-based reference for clinical practice. Of course, in the future, more scientific and rigorous conclusions need to be drawn from multi-center RCT research.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO, identifier CRD42022374141.

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Section: Discussionmentioning

confidence: 99%

A systematic review and meta-analysis of minimally invasive total mesorectal excision versus transanal total mesorectal excision for mid and low rectal cancer

杜刚¹,

Lin²,

Zhang³

et al. 2023

Front. Oncol.

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“…For patients meeting the surgical indications, surgical treatment is the main choice, and radical resection of RC is the only radical treatment for patients with RC at present [ 8 , 9 ]. However, according to the previous statistics, patients with RC still face the risk of local recurrence after surgery.…”

Section: Introductionmentioning

confidence: 99%

Correlation of Presacral Tumour Recurrence with Tumour Metastasis and Long-Term Tumour Recurrence Risk in Patients with Rectal Cancer

Wang¹,

Wu²,

Wang³

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Objective. To explore the risk factors that affect long-term presacral tumour recurrence in patients with rectal cancer (RC) after radical rectal cancer resection. Methods. In our study, a total of 50 patients with presacral tumour recurrence after radical resection of RC in our hospital between May 2017 and May 2018 were enrolled in the observation group, and the other 50 patients without presacral tumour recurrence after the resection over the same span were enrolled in the control group. The two groups were compared in distant metastatic rate and long-term recurrence, and corresponding K-M curves were drawn. Additionally, the quality of life of the two groups was also compared. Patients in both groups were assigned to a long-term recurrence group or a non-long-term recurrence group based on their long-term recurrence, and a multivariate logistic regression analysis was carried out for analysis of risk factors of long-term recurrence. Results. The two groups were not greatly different in clinical data ( P > 0.05 ). The observation group was higher than the control group in terms of distant metastasis and long-term recurrence ( P < 0.05 ). In addition, the MOS 36-Item Short-Form Health Survey (SF-36) scores of the observation group were all lower than those of the control group in the eight dimensions ( P < 0.05 ). Moreover, tumour diameter (OR: 0.315, 95% CI: 0.118–0.835), differentiation (OR: 2.652, 95% CI: 1.086–6.852), and presacral recurrence (OR: 2.370, 95% CI: 1.263–4.447) were all independent risk factors for long-term recurrence of patients undergoing radical resection of RC. Conclusions. Patients undergoing radical resection of RC face greatly higher risks of presacral tumour distant metastasis and long-term tumour recurrence, and tumour diameter ≥ 5 cm, low-differentiation degree, and presacral recurrence are independent risk factors for long-term recurrence of patients undergoing radical resection of RC. In the future, when performing radical resection of rectal cancer, it is necessary to pay attention to the changes in the above indicators in patients so as to prevent tumour recurrence.

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“…In 2010, transanal TME (TaTME) surgery in the field of rectal surgery was first reported by Sylla et al in the United States ( 9 ). Although it raises controversy in clinical application, some scholars believe that this procedure is a relatively safe and effective supplementary procedure, especially for patients with low rectal cancer ( 10 , 11 ). On the basis of TaTME, our team innovatively proposed a simple surgical approach for TaTME, using conventional multiport laparoscopy instead of single-port laparoscopy, and transanal resection of cancer tissue under direct vision, making the operation simpler and easier.…”

Section: Introductionmentioning

confidence: 99%

Simple transanal total mesorectal resection versus laparoscopic transabdominal total mesorectal resection for the treatment of low rectal cancer: a single-center retrospective case-control study

Yang

Chen

et al. 2023

Front. Surg.

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AimTo evaluate the efficacy and safety of simple TaTNE in the treatment of low rectal cancer compared with laparoscopic transabdominal TME.MethodsWe collected patients with low rectal cancer admitted to our hospital between January 2019 and November 2021 who received simple TaTME or laparoscopic transabdominal TME. The main outcome was the integrity of the TME specimen. Secondary outcomes were the number of lymph nodes dissected, intraoperative blood loss, operative time, surgical conversion rate, Specimen resection length, circumferential margin (CRM), and distal resection margin (DRM), complication rate. In addition, the Wexner score and LARS score of fecal incontinence were performed in postoperative follow-up.ResultsPathological tissues were successfully resected in all patients. all circumferential margins of the specimen were negative. Specimen resection length was not statistically significant (9.94 ± 2.85 vs. 8.90 ± 2.49, P > 0.05). The incidence of postoperative complications in group A (n = 0) was significantly lower than that in group B (n = 3) (P > 0.05). There was no significant difference in operation time between group A and group B (296 ± 60.36 vs. 305 ± 58.28, P > 0.05). Among the patients with follow-up time less than 1 year, there was no significant difference in Wexner score and LARS score between group A and group B (P > 0.05). However, in patients who were followed up for more than 1 year, the Wexner score in group A (9.25 ± 2.73) was significantly lower than that in group B (17.36 ± 10.95) and was statistically significant (P < 0.05).ConclusionFor radical resection of low rectal cancer, Simple TaTME resection may be as safe and effective as laparoscopic transabdominal TME, and the long-term prognosis may be better.

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Controversies and consensus in transanal total mesorectal excision (taTME): Is it a valid choice for rectal cancer?

Cited by 8 publications

References 37 publications

A systematic review and meta-analysis of minimally invasive total mesorectal excision versus transanal total mesorectal excision for mid and low rectal cancer

A systematic review and meta-analysis of minimally invasive total mesorectal excision versus transanal total mesorectal excision for mid and low rectal cancer

Correlation of Presacral Tumour Recurrence with Tumour Metastasis and Long-Term Tumour Recurrence Risk in Patients with Rectal Cancer

Simple transanal total mesorectal resection versus laparoscopic transabdominal total mesorectal resection for the treatment of low rectal cancer: a single-center retrospective case-control study

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