Kay T Choy1, Tze Wei Wilson Yang2, Swetha Prabhakaran2, Alexander Heriot3,4,5, Joseph C Kong6,7,8, Satish K Warrier2,3,4,5. 1. Department of Surgery, Austin Hospital, Melbourne, Victoria, Australia. 2. Department of Colorectal Surgery, Alfred Hospital, Melbourne, Victoria, Australia. 3. Division of Cancer Surgery, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia. 4. Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. 5. Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia. 6. Division of Cancer Surgery, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia. joekong@gmail.com. 7. Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. joekong@gmail.com. 8. Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia. joekong@gmail.com.
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.
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.
Authors: F Al-Rashid; S Robitaille; A S Liberman; P Charlebois; B Stein; L S Feldman; J F Fiore; L Lee Journal: Tech Coloproctol Date: 2022-01-18 Impact factor: 3.781
Authors: M X Bjoern; F B Clausen; M Seiersen; O Bulut; F Bech-Knudsen; J E Jansen; I Gögenur; M F Klein Journal: Int J Colorectal Dis Date: 2022-08-12 Impact factor: 2.796