Department of Gastroenterological Surgery, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, 100044, People's Republic of China.
Surg Endosc. 2018 Jun;32(6):2632-2642. doi: 10.1007/s00464-018-6103-6. Epub 2018 Feb 20.
Since 2010, comparative studies on transanal and laparoscopic total mesorectal excision (TME) have been published and it remains unclear about the oncological benefit from transanal total mesorectal excision (taTME).
We have searched English databases to identify all taTME studies published between January 2010 and August 2017. Pathological outcomes included circumferential resection margin (CRM), positive CRM (< 1 M), length of distal resection margin (DRM), positive DRM, quality of mesorectum (complete mesorectum), harvested lymph node, and length of the specimen. Odds ratios (ORs) were calculated for dichotomous outcomes and weighted mean differences (WMDs) for continuous outcomes.
We have included ten studies comprising of 762 patients. Compared with laparoscopic TME, taTME had a longer CRM (WMD, 0.833; 95% CI 0.366-1.299; P < 0.001), a lower positive rate of CRM (OR, 0.505; 95% CI 0.258-0.991; P = 0.047), and a longer DRM (WMD, 6.261; 95% CI 1.049-11.472; P = 0.019). There were no significant differences in other pathological outcomes. Both cumulative meta-analysis and sensitivity analysis were unable to detect potential sources of the heterogeneity in DRM. There was no evidence of publication bias.
This meta-analysis revealed that taTME had more advantages on positive CRM, CRM, and DRM compared with laparoscopic TME. Compared with laparoscopic TME, more benefits of taTME on pathological outcomes remained undetected. The current findings are all based on observational studies, RCTs with adequate power are required.
自 2010 年以来，已经发表了关于经肛门和腹腔镜全直肠系膜切除术（TME）的比较研究，但经肛门全直肠系膜切除术（taTME）的肿瘤学获益仍不清楚。
我们检索了英文数据库，以确定 2010 年 1 月至 2017 年 8 月期间发表的所有 taTME 研究。病理结果包括环周切缘（CRM）、CRM 阳性（<1mm）、远端切缘长度（DRM）、DRM 阳性、直肠系膜质量（完全直肠系膜）、淋巴结采集、标本长度。二分类结果计算比值比（OR），连续结果计算加权均数差（WMD）。
我们纳入了 10 项研究，共 762 例患者。与腹腔镜 TME 相比，taTME 的 CRM 更长（WMD，0.833；95%CI，0.366-1.299；P<0.001），CRM 阳性率更低（OR，0.505；95%CI，0.258-0.991；P=0.047），DRM 更长（WMD，6.261；95%CI，1.049-11.472；P=0.019）。其他病理结果无显著差异。累积荟萃分析和敏感性分析均未能发现 DRM 异质性的潜在来源。没有发表偏倚的证据。
这项荟萃分析显示，与腹腔镜 TME 相比，taTME 在 CRM、CRM 阳性和 DRM 方面具有更多优势。与腹腔镜 TME 相比，taTME 在病理结果方面的更多获益仍未被发现。目前的研究结果均基于观察性研究，需要进行具有足够效力的 RCT。
