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Pathological outcomes of transanal versus laparoscopic total mesorectal excision for rectal cancer: a systematic review with meta-analysis

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Abstract

Background

Since 2010, comparative studies on transanal and laparoscopic total mesorectal excision (TME) have been published and it remains unclear about the oncological benefit from transanal total mesorectal excision (taTME).

Methods

We have searched English databases to identify all taTME studies published between January 2010 and August 2017. Pathological outcomes included circumferential resection margin (CRM), positive CRM (< 1 M), length of distal resection margin (DRM), positive DRM, quality of mesorectum (complete mesorectum), harvested lymph node, and length of the specimen. Odds ratios (ORs) were calculated for dichotomous outcomes and weighted mean differences (WMDs) for continuous outcomes.

Results

We have included ten studies comprising of 762 patients. Compared with laparoscopic TME, taTME had a longer CRM (WMD, 0.833; 95% CI 0.366–1.299; P < 0.001), a lower positive rate of CRM (OR, 0.505; 95% CI 0.258–0.991; P = 0.047), and a longer DRM (WMD, 6.261; 95% CI 1.049–11.472; P = 0.019). There were no significant differences in other pathological outcomes. Both cumulative meta-analysis and sensitivity analysis were unable to detect potential sources of the heterogeneity in DRM. There was no evidence of publication bias.

Conclusions

This meta-analysis revealed that taTME had more advantages on positive CRM, CRM, and DRM compared with laparoscopic TME. Compared with laparoscopic TME, more benefits of taTME on pathological outcomes remained undetected. The current findings are all based on observational studies, RCTs with adequate power are required.

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Acknowledegement

Thanks to Prof. Choon Seng Chong, National University Hospital of Singapore, for his contribution in proofreading in English and other comments.

Funding

This work was supported by the National Natural Science Foundation of China (81572383).

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People’s Hospital, Beijing, 100044, People’s Republic of China

    Hong-Peng Jiang, Yan-Sen Li, Bo Wang, Chang Wang, Fan Liu, Zhan-Long Shen, Ying-Jiang Ye & Shan Wang

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  1. Hong-Peng Jiang
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  2. Yan-Sen Li
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  3. Bo Wang
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  4. Chang Wang
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  8. Shan Wang
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Corresponding authors

Correspondence to Zhan-Long Shen or Ying-Jiang Ye.

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Disclosures

Hong-Peng Jiang, Yan-Sen Li, Bo Wang, Fan Liu, Chang Wang, Zhan-Long Shen, Ying-Jiang Ye, and Shan Wang have no conflicts of interest or financial ties to disclose.

Additional information

Hong-Peng Jiang and Yan-Sen Li have equal first authorship.

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Jiang, HP., Li, YS., Wang, B. et al. Pathological outcomes of transanal versus laparoscopic total mesorectal excision for rectal cancer: a systematic review with meta-analysis. Surg Endosc 32, 2632–2642 (2018). https://doi.org/10.1007/s00464-018-6103-6

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  • DOI: https://doi.org/10.1007/s00464-018-6103-6

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