Deijen C L, Tsai A, Koedam T W A, Veltcamp Helbach M, Sietses C, Lacy A M, Bonjer H J, Tuynman J B
Department of Surgery, VU University Medical Centre, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
Department of Surgery and Cancer, Imperial College London, London, UK.
Tech Coloproctol. 2016 Dec;20(12):811-824. doi: 10.1007/s10151-016-1545-0. Epub 2016 Nov 16.
Transanal total mesorectal excision (TaTME) has been developed to improve quality of TME for patients with mid and low rectal cancer. However, despite enthusiastic uptake and teaching facilities, concern exists for safe introduction. TaTME is a complex procedure and potentially a learning curve will hamper clinical outcome. With this systematic review, we aim to provide data regarding morbidity and safety of TaTME. A systematic literature search was performed in MEDLINE (PubMed), EMBASE (Ovid) and Cochrane Library. Case reports, cohort series and comparative series on TaTME for rectal cancer were included. To evaluate a potential effect of case volume, low-volume centres (n ≤ 30 total volume) were compared with high-volume centres (n > 30 total volume). Thirty-three studies were identified (three case reports, 25 case series, five comparative studies), including 794 patients. Conversion was performed in 3.0% of the procedures. The complication rate was 40.3, and 11.5% were major complications. The quality of the mesorectum was "complete" in 87.6%, and the circumferential resection margin (CRM) was involved in 4.7%. In low- versus high-volume centres, the conversion rate was 4.3 versus 2.7%, and major complication rates were 12.2 versus 10.5%, respectively. TME quality was "complete" in 80.5 versus 89.7%, and CRM involvement was 4.8 and 4.5% in low- versus high-volume centres, respectively. TaTME for mid and low rectal cancer is a promising technique; however, it is associated with considerable morbidity. Safe implementation of the TaTME should include proctoring and quality assurance preferably within a trial setting.
经肛门全直肠系膜切除术（TaTME）已被开发用于提高中低位直肠癌患者的全直肠系膜切除术（TME）质量。然而，尽管该手术受到广泛欢迎且有教学设施，但对于其安全引入仍存在担忧。TaTME是一种复杂的手术，潜在的学习曲线可能会影响临床结果。通过本系统评价，我们旨在提供有关TaTME发病率和安全性的数据。在MEDLINE（PubMed）、EMBASE（Ovid）和Cochrane图书馆进行了系统的文献检索。纳入了关于TaTME治疗直肠癌的病例报告、队列研究和比较研究。为了评估病例数量的潜在影响，将低手术量中心（总手术量≤30例）与高手术量中心（总手术量>30例）进行了比较。共识别出33项研究（3例病例报告、25例病例系列、5项比较研究），包括794例患者。3.0%的手术进行了中转。并发症发生率为40.3%，其中11.5%为严重并发症。直肠系膜质量“完整”的比例为87.6%，环周切缘（CRM）受累的比例为4.7%。在低手术量中心与高手术量中心，中转率分别为4.3%和2.7%，严重并发症发生率分别为12.2%和10.5%。TME质量“完整”的比例在低手术量中心与高手术量中心分别为80.5%和89.7%，CRM受累率分别为4.8%和4.5%。TaTME治疗中低位直肠癌是一项有前景的技术；然而，它与相当高的发病率相关。TaTME的安全实施应包括在试验环境中进行监督和质量保证。
