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Background <p>The perioperative and oncological results of laparoscopic total mesorectal excision (laTME) and transanal total mesorectal excision (taTME) have been compared. However, because there are not enough high-quality randomized controlled trials (RCTs), the results cannot be trusted. In order to get more trustworthy results, this article analyzed matched cohort studies.</p> Methods <p>Until January 20, 2025, extensive searches were conducted across the Cochrane Library, Web of Science, Embase, and PubMed databases. Using meta-analysis and trial sequential analysis (TSA), we assessed the oncological and perioperative results. Quality assessment was done using the Newcastle–Ottawa Scale. To gauge the overall level of certainty in the evidence, we employed the Grading of Recommendations Assessment, Development, and Evaluation system (GRADE).</p> Results <p>6970 patients from 32 papers were included in the analysis. Comparing the taTME group to the laTME group, the open conversion rate (OR = 0.14, 95% CI = 0.09 to 0.22, <i>P</i> &lt; 0.01), circumferential resection margin (CRM) positivity rate (OR = 0.64, 95% CI = 0.49 to 0.85, <i>P</i> &lt; 0.01), and distal resection margin (DRM) positivity rate (OR = 0.57; 95% CI = 0.36 to 0.89; <i>P</i> = 0.01) were significantly lower. Other perioperative problems and oncological outcomes did not differ. The cumulative Z-curve for CRM positivity rate and&#xa0;open conversion both exceeded the conventional boundary and the trial sequential monitoring border, suggesting strong evidence; however, the DRM positivity rate showed possible false positives. In contrast to the poor CRM and DRM-positive rates, the recommendations for open conversion had a moderate grade.</p> Conclusion <p>Based on matched cohort studies, this meta-analysis shows that taTME may offer advantages in CRM positivity and open conversion rate but shows comparable results for other outcomes. To ascertain whether taTME offers benefits in terms of DRM positively, more investigation is required.</p> Graphic abstract <p></p>

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Outcomes of transanal versus laparoscopic total mesorectal excision for rectal cancer: a meta-analysis and trial sequential analysis of matched cohort studies

  • 期刊论文

  • 发表日期：

    2025年8月28日

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  • Lei Zhao,
  • Li Li,
  • Dianling Xiao,
  • Xuan Zhang,
  • Jun Ouyang,
  • Xiangheng Chen,
  • Qiulin Huang,
  • Shuai Xiao,
  • Xianhao Yi

摘要

Background

The perioperative and oncological results of laparoscopic total mesorectal excision (laTME) and transanal total mesorectal excision (taTME) have been compared. However, because there are not enough high-quality randomized controlled trials (RCTs), the results cannot be trusted. In order to get more trustworthy results, this article analyzed matched cohort studies.

Methods

Until January 20, 2025, extensive searches were conducted across the Cochrane Library, Web of Science, Embase, and PubMed databases. Using meta-analysis and trial sequential analysis (TSA), we assessed the oncological and perioperative results. Quality assessment was done using the Newcastle–Ottawa Scale. To gauge the overall level of certainty in the evidence, we employed the Grading of Recommendations Assessment, Development, and Evaluation system (GRADE).

Results

6970 patients from 32 papers were included in the analysis. Comparing the taTME group to the laTME group, the open conversion rate (OR = 0.14, 95% CI = 0.09 to 0.22, P < 0.01), circumferential resection margin (CRM) positivity rate (OR = 0.64, 95% CI = 0.49 to 0.85, P < 0.01), and distal resection margin (DRM) positivity rate (OR = 0.57; 95% CI = 0.36 to 0.89; P = 0.01) were significantly lower. Other perioperative problems and oncological outcomes did not differ. The cumulative Z-curve for CRM positivity rate and open conversion both exceeded the conventional boundary and the trial sequential monitoring border, suggesting strong evidence; however, the DRM positivity rate showed possible false positives. In contrast to the poor CRM and DRM-positive rates, the recommendations for open conversion had a moderate grade.

Conclusion

Based on matched cohort studies, this meta-analysis shows that taTME may offer advantages in CRM positivity and open conversion rate but shows comparable results for other outcomes. To ascertain whether taTME offers benefits in terms of DRM positively, more investigation is required.

Graphic abstract