Magdalena Mizera, Grzegorz Torbicz, Natalia Gajewska, Jan Witowski, Mateusz Rubinkiewicz, MD, PhD, Agata Czerwinska, MD, Piotr Zarzycki, MD, Piotr Malczak, MD, Piotr Major, MD, PhD, Michal Pedziwiatr, MD, PhD. 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
Background: Transanal total mesorectal excision (TaTME) is designed particularly to overcome the limits of open and laparoscopic approach. The data comparing this new technique with laparoscopy is constantly expanding. This meta-analysis is designed to compare TaTME with standard laparoscopic TME (LaTME).
Methods: We searched Medline, Embase and Scopus databases covering a up to July 2018. Inclusion criteria were: (1) study comparing laparoscopic resection of rectal cancer vs. TaTME for rectal cancer, (2) reporting of overall morbidity, operative time or major complications, (3) full text papers. The outcome measures were: overall morbidity, intraoperative adverse events, operative time, anastomotic leakage, intra-abdominal abscess, reoperations, length of hospital stay (LOS), oncological outcomes such as completeness of mesorectal excision, R0 resection rate, lymph node yield, distal resection margin (DRM) and circumferential resection margin (CRM).
Results: Ten studies were eligible with total of 698 patients. We found statistically significant differences in regard to major complications in favor of TaTME (6.03% vs. 12.24%: RR=0.52; 95%CI 0.25 – 0.96; p=0.04). We did not find significant differences regarding overall complications, intraoperative adverse effects, operative time, anastomotic leakage, intra-abdominal abscess occurrence, surgical site infections, reoperations and length of stay, completeness of mesorectal excision, R0 resection rate, number of harvested lymph nodes, DRM and CRM.
Conclusion: This is an updated meta-analysis including all most recently published trials. It shows benefits of TaTME technique in terms of major postoperative complications. In other clinic-pathological features TaTME is not superior to LaTME. Nonetheless, the quality of the data is still limited. To properly evaluate the feasibility, safety and efficacy of TaTME the results of large randomized trials are required.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94157
Program Number: P365
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster