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Comparing functional outcomes between transanal total mesorectal excision (TaTME) and laparoscopic total mesorectal excision (LaTME) for rectal cancer: a systematic review and meta-analysis

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Abstract

Background

There is concern that transanal total mesorectal excision (TaTME) may result in poorer functional outcomes as compared to laparoscopic TME (LaTME). These concerns arise from the fact that TaTME entails both a low anastomosis and prolonged dilatation of the anal sphincter from the transanal platform.

Objectives

This paper aimed to assess the comparative functional outcomes following TaTME and LaTME, with a focus on anorectal and genitourinary outcomes.

Data sources

A meta-analysis and systematic review was performed on available literature between 2000 and 2020 from the PubMed, EMBASE, Medline, and Cochrane Library databases.

Study selection

All comparative studies assessing the functional outcomes following taTME versus LaTME in adults were included.

Main outcome measure

Functional anorectal and genitourinary outcomes were evaluated using validated scoring systems.

Results

A total of seven studies were included, consisting of one randomised controlled trial and six non-randomised studies. There were 242 (52.0%) and 233 (48.0%) patients in the TaTME and LaTME groups respectively. Anorectal functional outcomes were similar in both groups with regard to LARS scores (30.6 in the TaTME group and 28.3 in the LaTME group), Jorge-Wexner incontinence scores, and EORTC QLQ C30/29 scores. Genitourinary function was similar in both groups with IPSS scores of 5.5 to 8.0 in the TaTME group, and 3.5 to 10.1 in the LaTME group. (p = 0.835).

Conclusion

This review corroborates findings from previous studies in showing that the transanal approach is not associated with increased anal sphincter damage. Further prospective clinical trials are needed in this field of research.

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Author notes

  1. Joseph C. Kong and Satish K Warrier are co-senior authors and have supervised this study equally.

Authors and Affiliations

  1. Department of Surgery, Austin Hospital, Melbourne, Victoria, Australia

    Kay T. Choy

  2. Department of Colorectal Surgery, Alfred Hospital, Melbourne, Victoria, Australia

    Tze Wei Wilson Yang, Swetha Prabhakaran & Satish K Warrier

  3. Division of Cancer Surgery, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia

    Alexander Heriot, Joseph C. Kong & Satish K Warrier

  4. Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

    Alexander Heriot, Joseph C. Kong & Satish K Warrier

  5. Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia

    Alexander Heriot, Joseph C. Kong & Satish K Warrier

Authors
  1. Kay T. Choy
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  2. Tze Wei Wilson Yang
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  4. Alexander Heriot
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Substantial contributions to the conception and design, acquisition of data, or analysis and interpretation of data: All authors

Drafting and revising the article: All authors

Final approval of the version to be published: All authors

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Correspondence to Joseph C. Kong.

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Kay T. Choy and Tze Wei Wilson Yang are co-first authors and have contributed to this study equally.

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Choy, K.T., Yang, T.W.W., Prabhakaran, S. et al. Comparing functional outcomes between transanal total mesorectal excision (TaTME) and laparoscopic total mesorectal excision (LaTME) for rectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis 36, 1163–1174 (2021). https://doi.org/10.1007/s00384-021-03849-2

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