Gang Du Yong, Dong Lin, DeChun Zhang, Yichi Zhang, Ya Lu
Department of Gastrointestinal Surgery, Pengzhou People's Hospital, Chengdu, Sichuan, China.
Department of Urology, Pengzhou People's Hospital, Chengdu, Sichuan, China.
Front Oncol. 2023 Jun 12;13:1167200. doi: 10.3389/fonc.2023.1167200. eCollection 2023.
Minimally invasive total mesorectal excision (MiTME) and transanal total mesorectal excision (TaTME) are popular trends in mid and low rectal cancer. However, there is currently no systematic comparison between MiTME and TaTME of mid and low-rectal cancer. Therefore, we systematically study the perioperative and pathological outcomes of MiTME and TaTME in mid and low rectal cancer.
We have searched the Embase, Cochrane Library, PubMed, Medline, and Web of Science for articles on MiTME (robotic or laparoscopic total mesorectal excision) and TaTME (transanal total mesorectal excision). We calculated pooled standard mean difference (SMD), relative risk (RR), and 95% confidence intervals (CIs). The protocol for this review has been registered on PROSPERO (CRD42022374141).
There are 11010 patients including 39 articles. Compared with TaTME, patients who underwent MiTME had no statistical difference in operation time (SMD -0.14; CI -0.31 to 0.33; I84.7%, P=0.116), estimated blood loss (SMD 0.05; CI -0.05 to 0.14; I48%, P=0.338), postoperative hospital stay (RR 0.08; CI -0.07 to 0.22; I0%, P=0.308), over complications (RR 0.98; CI 0.88 to 1.08; I25.4%, P=0.644), intraoperative complications (RR 0.94; CI 0.69 to 1.29; I31.1%, P=0.712), postoperative complications (RR 0.98; CI 0.87 to 1.11; I16.1%, P=0.789), anastomotic stenosis (RR 0.85; CI 0.73 to 0.98; I7.4%, P=0.564), wound infection (RR 1.08; CI 0.65 to 1.81; I1.9%, P=0.755), circumferential resection margin (RR 1.10; CI 0.91 to 1.34; I0%, P=0.322), distal resection margin (RR 1.49; CI 0.73 to 3.05; I0%, P=0.272), major low anterior resection syndrome (RR 0.93; CI 0.79 to 1.10; I0%, P=0.386), lymph node yield (SMD 0.06; CI -0.04 to 0.17; I39.6%, P=0.249), 2-year DFS rate (RR 0.99; CI 0.88 to 1.11; I0%, P = 0.816), 2-year OS rate (RR 1.00; CI 0.90 to 1.11; I0%, P = 0.969), distant metastasis rate (RR 0.47; CI 0.17 to 1.29; I0%, P = 0.143), and local recurrence rate (RR 1.49; CI 0.75 to 2.97; I0%, P = 0.250). However, patients who underwent MiTME had fewer anastomotic leak rates (SMD -0.38; CI -0.59 to -0.17; I19.0%, P<0.0001).
This study comprehensively and systematically evaluated the safety and efficacy of MiTME and TaTME in the treatment of mid to low-rectal cancer through meta-analysis. There is no difference between the two except for patients with MiTME who have a lower anastomotic leakage rate, which provides some evidence-based reference for clinical practice. Of course, in the future, more scientific and rigorous conclusions need to be drawn from multi-center RCT research.
https://www.crd.york.ac.uk/PROSPERO, identifier CRD42022374141.
微创全直肠系膜切除术（MiTME）和经肛门全直肠系膜切除术（TaTME）是中低位直肠癌治疗的流行趋势。然而，目前尚无关于中低位直肠癌MiTME与TaTME的系统比较。因此，我们系统地研究了MiTME和TaTME治疗中低位直肠癌的围手术期和病理结果。
我们检索了Embase、Cochrane图书馆、PubMed、Medline和Web of Science上关于MiTME（机器人或腹腔镜全直肠系膜切除术）和TaTME（经肛门全直肠系膜切除术）的文章。我们计算了合并标准平均差（SMD）、相对风险（RR）和95%置信区间（CIs）。本综述的方案已在PROSPERO（CRD42022374141）上注册。
共纳入11010例患者的39篇文章。与TaTME相比，接受MiTME的患者在手术时间（SMD -0.14；CI -0.31至0.33；I²84.7%，P = 0.116）、估计失血量（SMD 0.05；CI -0.05至0.14；I²48%，P = 0.338）、术后住院时间（RR 0.08；CI -0.07至0.22；I²0%，P = 0.308）、总体并发症（RR 0.98；CI 0.88至1.08；I²25.4%，P = 0.644）、术中并发症（RR 0.94；CI 0.69至1.29；I²31.1%，P = 0.712）、术后并发症（RR 0.98；CI 0.87至1.11；I²16.1%，P = 0.789）、吻合口狭窄（RR 0.85；CI 0.73至0.98；I²7.4%，P = 0.564）、伤口感染（RR 1.08；CI 0.65至1.81；I²1.9%，P = 0.755）、环周切缘（RR 1.10；CI 0.91至1.34；I²0%，P = 0.322）、远端切缘（RR 1.49；CI 0.73至3.05；I²0%，P = 0.272）、严重低位前切除综合征（RR 0.93；CI 0.79至1.10；I²0%，P = 0.386）、淋巴结获取数量（SMD 0.06；CI -0.04至0.17；I²39.6%，P = 0.249）、2年无病生存率（RR 0.99；CI 0.88至1.11；I²0%，P = 0.816）、2年总生存率（RR 1.00；CI 0.90至1.11；I²0%，P = 0.969）、远处转移率（RR 0.47；CI 0.17至1.29；I²0%，P = 0.143）和局部复发率（RR 1.49；CI 0.75至2.97；I²0%，P = 0.250）方面无统计学差异。然而，接受MiTME的患者吻合口漏发生率较低（SMD -0.38；CI -0.59至-0.17；I²19.0%，P < 0.0001）。
本研究通过荟萃分析全面系统地评估了MiTME和TaTME治疗中低位直肠癌的安全性和有效性。两者之间除MiTME患者吻合口漏发生率较低外无差异，为临床实践提供了一些循证参考。当然，未来还需要多中心随机对照试验研究得出更科学严谨的结论。
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