Short-term Efficacy Of Transanal Total Mesorectal Excision For Middle And Low Rectal Cancer:a Meta-analysis

Objective:To evaluate and compare the transanal total mesorectal excision(TaTME)and laparoscopic total mesorectal excision(LaTME)in the short-term efficacy of low and middle rectal cancer.And analyze the feasibility and safety of TaTME operation.Methods:To screen and analyse the relevant studies on the efficacy and safety of comparative TaTME and LaTME in low rectal cancer published before December 2019 from Pubmed,Embase,Web of Science,Weip,Wanfang,Zhiwang and China Biomedical Literature Database(CBM)and other comprehensive large databases.Evaluating the included literature with NOS quality evaluation form(Newcastlee-Ottawa Scale,NOS).And the Review Manager 5.3 version is employed to analysis the data integration.Results:27 articles were included in the literature,and 1355 in TaTME group and 1428 in LaTME group.Meta analysis shows that,TaTME had lower circumferential margin positive rate(OR=0.35,95%CI=0.16~0.78,P=0.0003),higher R0(no residual cancer cells under microscope)resection rate(OR=1.67,95%CI=1.12~2.50,P=0.01),less intraoperative bleeding volume(MD=-16.38,95%CI=-27.08~-5.67,P=0.003),lower conversion to an open surgery rate(OR=0.19,95%CI=0.11~0.32,P<0.00001),and shorter hospital stay(MD=-1.26,95%CI=-1.93~-0.59,P=0.0002)than LaTME.There was no significant difference between the two groups in terms of CRM distance,DRM distance,DRM positive rate,complete mesenteric resection rate,number of lymph node acquisition,overall complication rate during operation,length of operation,overall complication rate after operation,anastomotic fistula rate and infection rate in the operation area.Conclusion:This study shows that TaTME has some advantages over LaTME in the positive rate of circumferential margin such as the rate of R0 resection,the amount of intraoperative bleeding,the rate of transit opening,and the length of hospitalization.So,we think that TaTME is safe and feasible in the treatment of middle and low rectal cancer.This conclusion has some limitations and needs more high quality randomized controlled trials to confirm.