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Meta-analysis of transanal vs laparoscopic total mesorectal excision of low rectal cancer:Importance of appropriate patient selection

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World Journal of Gastrointestinal Surgery 2022年第12期14卷 1397-1410页

作者： pratik bhattacharya Ishaan Patel Noureen Fazili Shahab Hajibandeh Shahin Hajibandeh Department of Surgery Sandwell and West Birmingham Hospitals NHS TrustBirmingham B714HJUnited Kingdom Department of Surgery Queen Elizabeth Hospital BirminghamBirmingham B152GWUnited Kingdom Department of Surgery University Hospital of WalesCardiff CF144XWUnited Kingdom Department of Surgery Royal Stoke University HospitalStoke-on-Trent ST46QGUnited Kingdom

BACKGROUND Achieving a clear resection margins for low rectal cancer is technically *** approach to total mesorectal excision(TME)was introduced in order to address the challenges associated with the laparoscopic approach in treating low rectal ***,previous meta-analyses have included mixed population with mid and low rectal tumours when comparing both approaches which has made the interpretation of the real differences between two approaches in treating low rectal cancer *** To investigate the outcomes of transanal TME(TaTME)and laparoscopic TME(LaTME)in patients with low rectal *** A comprehensive systematic review of comparative studies was performed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses *** and postoperative complications,anastomotic leak,R0 resection,completeness of mesorectal excision,circumferential resection margin(CRM),distal resection margin(DRM),harvested lymph nodes,and operation time were the investigated outcome *** We included twelve comparative studies enrolling 969 patients comparing TaTME(n=969)and LaTME(n=476)in patients with low rectal *** was associated with significantly lower risk of postoperative complications(OR:0.74,P=0.04),anastomotic leak(OR:0.59,P=0.02),and conversion to an open procedure(OR:0.29,P=0.002)in comparison with ***,the rate of R0 resection was significantly higher in the TaTME group(OR:1.96,P=0.03).Nevertheless,TaTME and LaTME were comparable in terms of rate of intraoperative complications(OR:1.87;P=0.23),completeness of mesoractal excision(OR:1.57,P=0.15),harvested lymph nodes(MD:-0.05,P=0.96),DRM(MD:-0.94;P=0.17),CRM(MD:1.08,P=0.17),positive CRM(OR:0.64,P=0.11)and procedure time(MD:-6.99 min,P=0.45).CONCLUSION Our findings indicated that for low rectal tumours,TaTME is associated with better clinical and short term oncological outcomes compared to *** randomised controll

关键词： Total mesorectal excision Laparoscopic Transanal Rectal cancer

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