Comparison Of TaTME And Traditional Laparoscopic Total Mesorectal Resection In The Treatment Of Rectal Cancer:A Meta-Analysis

Objective:To evaluate the efficacy of transanal total mesorectal excision(Ta TME)and traditional abdominal laparoscopic total mesorectal excision(La TME)in the treatment of rectal cancer by meta-analysis.Methods:Medical databases such as PubMed,Cochrane Library,Web of science,Embase and CBM were searched by computer.The search period is limited to December 2022,and the limited language is English.All the literatures containing keywords were searched,and the obtained literatures were preliminarily screened,and the literatures that were obviously inconsistent with the inclusion criteria and with low scores were excluded.The data from the finally included high-quality literature were extracted.Then,a systematic Review and meta-analysis were conducted on 20 indicators of surgical outcomes.Review Manager 5.3 and Stata MP 16.0 were used to merge and analyze the obtained data,and fixed or random effects models were selected according to the level of statistical heterogeneity.Medical databases such as Pub Med,Cochrane Library,Web of science,Embase and CBM were searched by computer.The search period is limited to December 2022,and the limited language is English.All the literatures containing keywords were searched,and the obtained literatures were preliminarily screened,and the literatures that were obviously inconsistent with the inclusion criteria and with low scores were excluded.The data from the finally included high-quality literature were extracted.Then,a systematic Review and meta-analysis were conducted on 20 indicators of surgical outcomes.Review Manager 5.3 and Stata MP 16.0 were used to merge and analyze the obtained data,and fixed or random effects models were selected according to the level of statistical heterogeneity.Results:A total of 32 English articles were included in this study,including 6 randomized controlled trials and the rest were cohort studies.A total of 9535 patients were enrolled in this study,including 4711 cases in the Ta TME group and 4824 cases in the La TME group.In addition,there was no statistically significant difference in age and BMI of patients,which had no significant effect on the outcome indicators related to surgery.The results of Meta-analysis showed that the Ta TME group was better than the La TME group in terms of intraoperative conversion rate,CRM distance,length of hospital stay,incidence of postoperative incision complications,incidence of postoperative urinary complications,postoperative analgesic application rate,and readmission rate,and the difference was statistically significant(P < 0.05).However,in terms of IPSS(prostate function)score and LARS(low anterior resection syndrome)score,the Ta TME group was at a disadvantage,and the difference was statistically significant(P < 0.05).In terms of operation time,number of lymph nodes harvested,intraoperative blood loss,intraoperative complications,complete rate of mesorectal excision,overall postoperative complications,postoperative severe complications(Clavien ≥ Ⅲ),anastomotic leakage,postoperative respiratory complications,postoperative mortality,local recurrence rate,etc.The results showed that there was no significant difference between the two groups(P > 0.05).Conclusion:According to the data of the existing literature,the results obtained show that transanal TME and traditional transabdominal laparoscopic TME have certain advantages in the surgical effect.However,the sample size of some outcome indicators in the perioperative period is small,and large-scale randomized controlled trials are still needed to verify.