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Statistical, Clinical, Methodological Evaluation of Local Recurrence Following Transanal Total Mesorectal Excision
Hans H Wasmuth1, Mahir Gachabayov2, Les Bokey3
1Department of Gastrointestinal Surgery, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
Diseases of the Colon and Rectum
|May 3, 2021
Summary
Transanal total mesorectal excision (TaTME) for rectal cancer shows a 3.4% local recurrence rate. However, significant clinical and methodological issues in studies mean evidence remains inconclusive.
Area of Science:
- Colorectal Surgery
- Surgical Oncology
- Evidence-Based Medicine
Background:
- A Norwegian moratorium questioned transanal total mesorectal excision (TaTME) due to reported increases in local recurrences.
- This has raised concerns regarding the oncological safety and efficacy of TaTME for rectal cancer treatment.
Purpose of the Study:
- To systematically review and meta-analyze local recurrence rates after TaTME.
- To critically assess statistical, clinical, and methodological biases in existing TaTME literature.
Main Methods:
- Systematic search of PubMed and MEDLINE databases.
- Inclusion of descriptive/comparative studies with at least 6 months follow-up.
- Meta-analysis using untransformed proportion method; meta-regression for risk factors; heterogeneity assessment (I², τ², clinical, methodological).
Main Results:
- Pooled local recurrence rate of 3.4% (95% CI: 2.7%-4.0%) across 29 studies (2906 patients) at an average of 20.1 months.
- No significant correlation found between TaTME quality, margin status, and recurrence rates.
- Substantial clinical and methodological heterogeneity identified, impacting evidence quality.
Conclusions:
- The pooled local recurrence rate for TaTME is 3.4% at 20 months.
- Significant clinical and methodological heterogeneity across studies renders current evidence inconclusive.
- Further high-quality research is needed to definitively establish TaTME's safety and efficacy.
