Meta-analysis of transanal total mesorectal excision versus laparoscopic total mesorectal excision in management of rectal cancer
Objectives To evaluate comparative outcomes of transanal total mesorectal excision (TaTME) and laparoscopic TME (LaTME) in patients with rectal cancer. Methods We systematically searched multiple databases and bibliographic reference lists. A combination of free text and controlled vocabulary search...
Gespeichert in:
| Veröffentlicht in: | International journal of colorectal disease 2020-04, Vol.35 (4), p.575-593 |
|---|---|
| Hauptverfasser: | , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 593 |
|---|---|
| container_issue | 4 |
| container_start_page | 575 |
| container_title | International journal of colorectal disease |
| container_volume | 35 |
| creator | Hajibandeh, Shahin Hajibandeh, Shahab Eltair, Mokhtar George, Anil T. Thumbe, Vijay Torrance, Andrew W. Budhoo, Misra Joy, Howard Peravali, Rajeev |
| description | Objectives
To evaluate comparative outcomes of transanal total mesorectal excision (TaTME) and laparoscopic TME (LaTME) in patients with rectal cancer.
Methods
We systematically searched multiple databases and bibliographic reference lists. A combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators, and limits were applied. Overall intraoperative complications, overall postoperative complications, anastomotic leak, surgical site infections (SSIs), completeness of mesorectal excision, R0 resection, distal (DRM) and circumferential resection margin (CRM), number of harvested lymph nodes, and procedure time were the evaluated outcome parameters.
Results
We identified 18 comparative studies reporting a total of 2048 patients evaluating outcomes of TaTME (
n
= 1000) and LaTME (
n
= 1048) in patients with rectal cancer. TaTME was associated with significantly higher number of R0 resection (OR 1.67,
P
= 0.01) and harvested lymph nodes (MD 1.08, P = 0.01), and lower rate of positive CRM (OR 0.67,
P
= 0.04) and conversion to an open procedure (OR 0.17,
P
|
| doi_str_mv | 10.1007/s00384-020-03545-7 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_2370537017</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A714487839</galeid><sourcerecordid>A714487839</sourcerecordid><originalsourceid>FETCH-LOGICAL-c414t-8d7c64fd8475457a4968d44dc3e89d866b5f26859d627333a8c198e1053a6f9b3</originalsourceid><addsrcrecordid>eNp9kU1rFTEUhoMo9rb6B1zIgBs3qfmaJLMspWqh4kbXITdz5pIyk1xzZsQu_edmnKsgSAnk4-R5T07OS8grzi45Y-YdMiatokwwymSrWmqekB1XUlAutHhKdoybjvKutWfkHPGe1bM26jk5k4ILxZTZkZ-fYPbUJz8-YMQmD81cfMI10Mx5rvMEmAuEdQs_QsSYU_MdCi7YjP7oS8aQjzE8QsfUTDXhASZI8_rECQg-BSgvyLPBjwgvT-sF-fr-5sv1R3r3-cPt9dUdDYqrmdreBK2G3ipTv2q86rTtleqDBNv1Vut9Owht267XwkgpvQ28s8BZK70eur28IG-3vMeSvy2As5siBhhHnyAv6IQ0lTW1RxV9s6EHP4KLaci1KWHF3ZXhSlljZVepy_9QdfQwxZATDLHG_xGITRBq07DA4I4lTr48OM7c6qjbHHXVUffbUbfW8vpU9rKfoP8r-WNhBeQGYL1KByjuPi-l-oePpf0Fv7usdA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2370537017</pqid></control><display><type>article</type><title>Meta-analysis of transanal total mesorectal excision versus laparoscopic total mesorectal excision in management of rectal cancer</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Hajibandeh, Shahin ; Hajibandeh, Shahab ; Eltair, Mokhtar ; George, Anil T. ; Thumbe, Vijay ; Torrance, Andrew W. ; Budhoo, Misra ; Joy, Howard ; Peravali, Rajeev</creator><creatorcontrib>Hajibandeh, Shahin ; Hajibandeh, Shahab ; Eltair, Mokhtar ; George, Anil T. ; Thumbe, Vijay ; Torrance, Andrew W. ; Budhoo, Misra ; Joy, Howard ; Peravali, Rajeev</creatorcontrib><description>Objectives
To evaluate comparative outcomes of transanal total mesorectal excision (TaTME) and laparoscopic TME (LaTME) in patients with rectal cancer.
Methods
We systematically searched multiple databases and bibliographic reference lists. A combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators, and limits were applied. Overall intraoperative complications, overall postoperative complications, anastomotic leak, surgical site infections (SSIs), completeness of mesorectal excision, R0 resection, distal (DRM) and circumferential resection margin (CRM), number of harvested lymph nodes, and procedure time were the evaluated outcome parameters.
Results
We identified 18 comparative studies reporting a total of 2048 patients evaluating outcomes of TaTME (
n
= 1000) and LaTME (
n
= 1048) in patients with rectal cancer. TaTME was associated with significantly higher number of R0 resection (OR 1.67,
P
= 0.01) and harvested lymph nodes (MD 1.08, P = 0.01), and lower rate of positive CRM (OR 0.67,
P
= 0.04) and conversion to an open procedure (OR 0.17,
P
< 0.00001) compared with LaTME. However, there was no significant difference in intraoperative complications (OR 1.18,
P
= 0.54), postoperative complications (OR 0.89,
P
= 0.24), anastomotic leak (OR 0.88,
P
= 0.42), SSIs (OR 0.64,
P
= 0.26), completeness of mesorectal excision (OR 1.43,
P
= 0.19), DRM (MD 1.87,
P
= 0.16), CRM (MD 0.36,
P
= 0.58), and procedure time (MD − 10.87,
P
= 0.18) between TaTME and LaTME. Moreover, for low rectal tumours, TaTME was associated with significantly lower rate of anastomotic leak and higher number of lymph nodes (MD 2.06,
P
= 0.002).
Conclusions
Although the meta-analysis of best available evidence (level 2) demonstrated that TaTME may be associated with better short-term oncological outcomes and similar clinical outcomes compared with LaTME, the differences between the two groups were small questioning their clinical relevance. No solid conclusions can be made due to lack of high quality randomised studies.</description><identifier>ISSN: 0179-1958</identifier><identifier>EISSN: 1432-1262</identifier><identifier>DOI: 10.1007/s00384-020-03545-7</identifier><identifier>PMID: 32124047</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Aged ; Anal Canal - surgery ; Anastomotic Leak - etiology ; Colorectal cancer ; Comparative analysis ; Conversion to Open Surgery ; Customer relationship management software ; Female ; Gastroenterology ; Health aspects ; Hepatology ; Humans ; Internal Medicine ; Intraoperative Complications - etiology ; Laparoscopic surgery ; Laparoscopy ; Laparoscopy - adverse effects ; Lymph Nodes - pathology ; Male ; Medical research ; Medicine ; Medicine & Public Health ; Medicine, Experimental ; Middle Aged ; Observational Studies as Topic ; Postoperative Complications - etiology ; Proctology ; Publication Bias ; Rectal Neoplasms - surgery ; Rectum - surgery ; Review ; Risk ; Surgery ; Surgical Wound Infection - etiology ; Time Factors</subject><ispartof>International journal of colorectal disease, 2020-04, Vol.35 (4), p.575-593</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2020</rights><rights>COPYRIGHT 2020 Springer</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c414t-8d7c64fd8475457a4968d44dc3e89d866b5f26859d627333a8c198e1053a6f9b3</citedby><cites>FETCH-LOGICAL-c414t-8d7c64fd8475457a4968d44dc3e89d866b5f26859d627333a8c198e1053a6f9b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00384-020-03545-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00384-020-03545-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32124047$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hajibandeh, Shahin</creatorcontrib><creatorcontrib>Hajibandeh, Shahab</creatorcontrib><creatorcontrib>Eltair, Mokhtar</creatorcontrib><creatorcontrib>George, Anil T.</creatorcontrib><creatorcontrib>Thumbe, Vijay</creatorcontrib><creatorcontrib>Torrance, Andrew W.</creatorcontrib><creatorcontrib>Budhoo, Misra</creatorcontrib><creatorcontrib>Joy, Howard</creatorcontrib><creatorcontrib>Peravali, Rajeev</creatorcontrib><title>Meta-analysis of transanal total mesorectal excision versus laparoscopic total mesorectal excision in management of rectal cancer</title><title>International journal of colorectal disease</title><addtitle>Int J Colorectal Dis</addtitle><addtitle>Int J Colorectal Dis</addtitle><description>Objectives
To evaluate comparative outcomes of transanal total mesorectal excision (TaTME) and laparoscopic TME (LaTME) in patients with rectal cancer.
Methods
We systematically searched multiple databases and bibliographic reference lists. A combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators, and limits were applied. Overall intraoperative complications, overall postoperative complications, anastomotic leak, surgical site infections (SSIs), completeness of mesorectal excision, R0 resection, distal (DRM) and circumferential resection margin (CRM), number of harvested lymph nodes, and procedure time were the evaluated outcome parameters.
Results
We identified 18 comparative studies reporting a total of 2048 patients evaluating outcomes of TaTME (
n
= 1000) and LaTME (
n
= 1048) in patients with rectal cancer. TaTME was associated with significantly higher number of R0 resection (OR 1.67,
P
= 0.01) and harvested lymph nodes (MD 1.08, P = 0.01), and lower rate of positive CRM (OR 0.67,
P
= 0.04) and conversion to an open procedure (OR 0.17,
P
< 0.00001) compared with LaTME. However, there was no significant difference in intraoperative complications (OR 1.18,
P
= 0.54), postoperative complications (OR 0.89,
P
= 0.24), anastomotic leak (OR 0.88,
P
= 0.42), SSIs (OR 0.64,
P
= 0.26), completeness of mesorectal excision (OR 1.43,
P
= 0.19), DRM (MD 1.87,
P
= 0.16), CRM (MD 0.36,
P
= 0.58), and procedure time (MD − 10.87,
P
= 0.18) between TaTME and LaTME. Moreover, for low rectal tumours, TaTME was associated with significantly lower rate of anastomotic leak and higher number of lymph nodes (MD 2.06,
P
= 0.002).
Conclusions
Although the meta-analysis of best available evidence (level 2) demonstrated that TaTME may be associated with better short-term oncological outcomes and similar clinical outcomes compared with LaTME, the differences between the two groups were small questioning their clinical relevance. No solid conclusions can be made due to lack of high quality randomised studies.</description><subject>Aged</subject><subject>Anal Canal - surgery</subject><subject>Anastomotic Leak - etiology</subject><subject>Colorectal cancer</subject><subject>Comparative analysis</subject><subject>Conversion to Open Surgery</subject><subject>Customer relationship management software</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Health aspects</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Intraoperative Complications - etiology</subject><subject>Laparoscopic surgery</subject><subject>Laparoscopy</subject><subject>Laparoscopy - adverse effects</subject><subject>Lymph Nodes - pathology</subject><subject>Male</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Medicine, Experimental</subject><subject>Middle Aged</subject><subject>Observational Studies as Topic</subject><subject>Postoperative Complications - etiology</subject><subject>Proctology</subject><subject>Publication Bias</subject><subject>Rectal Neoplasms - surgery</subject><subject>Rectum - surgery</subject><subject>Review</subject><subject>Risk</subject><subject>Surgery</subject><subject>Surgical Wound Infection - etiology</subject><subject>Time Factors</subject><issn>0179-1958</issn><issn>1432-1262</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU1rFTEUhoMo9rb6B1zIgBs3qfmaJLMspWqh4kbXITdz5pIyk1xzZsQu_edmnKsgSAnk4-R5T07OS8grzi45Y-YdMiatokwwymSrWmqekB1XUlAutHhKdoybjvKutWfkHPGe1bM26jk5k4ILxZTZkZ-fYPbUJz8-YMQmD81cfMI10Mx5rvMEmAuEdQs_QsSYU_MdCi7YjP7oS8aQjzE8QsfUTDXhASZI8_rECQg-BSgvyLPBjwgvT-sF-fr-5sv1R3r3-cPt9dUdDYqrmdreBK2G3ipTv2q86rTtleqDBNv1Vut9Owht267XwkgpvQ28s8BZK70eur28IG-3vMeSvy2As5siBhhHnyAv6IQ0lTW1RxV9s6EHP4KLaci1KWHF3ZXhSlljZVepy_9QdfQwxZATDLHG_xGITRBq07DA4I4lTr48OM7c6qjbHHXVUffbUbfW8vpU9rKfoP8r-WNhBeQGYL1KByjuPi-l-oePpf0Fv7usdA</recordid><startdate>20200401</startdate><enddate>20200401</enddate><creator>Hajibandeh, Shahin</creator><creator>Hajibandeh, Shahab</creator><creator>Eltair, Mokhtar</creator><creator>George, Anil T.</creator><creator>Thumbe, Vijay</creator><creator>Torrance, Andrew W.</creator><creator>Budhoo, Misra</creator><creator>Joy, Howard</creator><creator>Peravali, Rajeev</creator><general>Springer Berlin Heidelberg</general><general>Springer</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20200401</creationdate><title>Meta-analysis of transanal total mesorectal excision versus laparoscopic total mesorectal excision in management of rectal cancer</title><author>Hajibandeh, Shahin ; Hajibandeh, Shahab ; Eltair, Mokhtar ; George, Anil T. ; Thumbe, Vijay ; Torrance, Andrew W. ; Budhoo, Misra ; Joy, Howard ; Peravali, Rajeev</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c414t-8d7c64fd8475457a4968d44dc3e89d866b5f26859d627333a8c198e1053a6f9b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>Anal Canal - surgery</topic><topic>Anastomotic Leak - etiology</topic><topic>Colorectal cancer</topic><topic>Comparative analysis</topic><topic>Conversion to Open Surgery</topic><topic>Customer relationship management software</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>Health aspects</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Intraoperative Complications - etiology</topic><topic>Laparoscopic surgery</topic><topic>Laparoscopy</topic><topic>Laparoscopy - adverse effects</topic><topic>Lymph Nodes - pathology</topic><topic>Male</topic><topic>Medical research</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Medicine, Experimental</topic><topic>Middle Aged</topic><topic>Observational Studies as Topic</topic><topic>Postoperative Complications - etiology</topic><topic>Proctology</topic><topic>Publication Bias</topic><topic>Rectal Neoplasms - surgery</topic><topic>Rectum - surgery</topic><topic>Review</topic><topic>Risk</topic><topic>Surgery</topic><topic>Surgical Wound Infection - etiology</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hajibandeh, Shahin</creatorcontrib><creatorcontrib>Hajibandeh, Shahab</creatorcontrib><creatorcontrib>Eltair, Mokhtar</creatorcontrib><creatorcontrib>George, Anil T.</creatorcontrib><creatorcontrib>Thumbe, Vijay</creatorcontrib><creatorcontrib>Torrance, Andrew W.</creatorcontrib><creatorcontrib>Budhoo, Misra</creatorcontrib><creatorcontrib>Joy, Howard</creatorcontrib><creatorcontrib>Peravali, Rajeev</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of colorectal disease</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hajibandeh, Shahin</au><au>Hajibandeh, Shahab</au><au>Eltair, Mokhtar</au><au>George, Anil T.</au><au>Thumbe, Vijay</au><au>Torrance, Andrew W.</au><au>Budhoo, Misra</au><au>Joy, Howard</au><au>Peravali, Rajeev</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Meta-analysis of transanal total mesorectal excision versus laparoscopic total mesorectal excision in management of rectal cancer</atitle><jtitle>International journal of colorectal disease</jtitle><stitle>Int J Colorectal Dis</stitle><addtitle>Int J Colorectal Dis</addtitle><date>2020-04-01</date><risdate>2020</risdate><volume>35</volume><issue>4</issue><spage>575</spage><epage>593</epage><pages>575-593</pages><issn>0179-1958</issn><eissn>1432-1262</eissn><abstract>Objectives
To evaluate comparative outcomes of transanal total mesorectal excision (TaTME) and laparoscopic TME (LaTME) in patients with rectal cancer.
Methods
We systematically searched multiple databases and bibliographic reference lists. A combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators, and limits were applied. Overall intraoperative complications, overall postoperative complications, anastomotic leak, surgical site infections (SSIs), completeness of mesorectal excision, R0 resection, distal (DRM) and circumferential resection margin (CRM), number of harvested lymph nodes, and procedure time were the evaluated outcome parameters.
Results
We identified 18 comparative studies reporting a total of 2048 patients evaluating outcomes of TaTME (
n
= 1000) and LaTME (
n
= 1048) in patients with rectal cancer. TaTME was associated with significantly higher number of R0 resection (OR 1.67,
P
= 0.01) and harvested lymph nodes (MD 1.08, P = 0.01), and lower rate of positive CRM (OR 0.67,
P
= 0.04) and conversion to an open procedure (OR 0.17,
P
< 0.00001) compared with LaTME. However, there was no significant difference in intraoperative complications (OR 1.18,
P
= 0.54), postoperative complications (OR 0.89,
P
= 0.24), anastomotic leak (OR 0.88,
P
= 0.42), SSIs (OR 0.64,
P
= 0.26), completeness of mesorectal excision (OR 1.43,
P
= 0.19), DRM (MD 1.87,
P
= 0.16), CRM (MD 0.36,
P
= 0.58), and procedure time (MD − 10.87,
P
= 0.18) between TaTME and LaTME. Moreover, for low rectal tumours, TaTME was associated with significantly lower rate of anastomotic leak and higher number of lymph nodes (MD 2.06,
P
= 0.002).
Conclusions
Although the meta-analysis of best available evidence (level 2) demonstrated that TaTME may be associated with better short-term oncological outcomes and similar clinical outcomes compared with LaTME, the differences between the two groups were small questioning their clinical relevance. No solid conclusions can be made due to lack of high quality randomised studies.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>32124047</pmid><doi>10.1007/s00384-020-03545-7</doi><tpages>19</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0179-1958 |
| ispartof | International journal of colorectal disease, 2020-04, Vol.35 (4), p.575-593 |
| issn | 0179-1958 1432-1262 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2370537017 |
| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Aged Anal Canal - surgery Anastomotic Leak - etiology Colorectal cancer Comparative analysis Conversion to Open Surgery Customer relationship management software Female Gastroenterology Health aspects Hepatology Humans Internal Medicine Intraoperative Complications - etiology Laparoscopic surgery Laparoscopy Laparoscopy - adverse effects Lymph Nodes - pathology Male Medical research Medicine Medicine & Public Health Medicine, Experimental Middle Aged Observational Studies as Topic Postoperative Complications - etiology Proctology Publication Bias Rectal Neoplasms - surgery Rectum - surgery Review Risk Surgery Surgical Wound Infection - etiology Time Factors |
| title | Meta-analysis of transanal total mesorectal excision versus laparoscopic total mesorectal excision in management of rectal cancer |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-06T19%3A06%3A59IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_proqu&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Meta-analysis%20of%20transanal%20total%20mesorectal%20excision%20versus%20laparoscopic%20total%20mesorectal%20excision%20in%20management%20of%20rectal%20cancer&rft.jtitle=International%20journal%20of%20colorectal%20disease&rft.au=Hajibandeh,%20Shahin&rft.date=2020-04-01&rft.volume=35&rft.issue=4&rft.spage=575&rft.epage=593&rft.pages=575-593&rft.issn=0179-1958&rft.eissn=1432-1262&rft_id=info:doi/10.1007/s00384-020-03545-7&rft_dat=%3Cgale_proqu%3EA714487839%3C/gale_proqu%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2370537017&rft_id=info:pmid/32124047&rft_galeid=A714487839&rfr_iscdi=true |