EAES, ESCP, and ESGAR update on taTME for rectal cancer-systematic review and meta-analysis

We performed a systematic review and meta-analysis comparing patient-important outcomes among different surgical approaches to total mesorectal excision (TME) for patients with rectal cancer.

We searched PubMed, Embase, and Cochrane Central to identify articles of interest published prior to October 17th, 2024, to identify RCTs and observational studies comparing outcomes between transanal TME (taTME), laparoscopic TME (laTME), and robotic TME (roTME) for patients with low- and mid-rectal cancers. The multidisciplinary panel prioritized outcomes and established objective decision thresholds a priori. Two reviewers completed article screening, data extraction, and risk of bias appraisal. We performed a random effects meta-analysis. We conducted a sensitivity analysis to compare the durability of results between studies at low/moderate versus high risk of bias.

We identified 35 reports of 32 studies from 8,228 articles. Patients had a mean age ± standard deviation (SD) of 62.6 ± 14.0, 62.6 ± 14.1, and 63.2 ± 12.7 years for patients that underwent taTME, laTME, and roTME, respectively. Most patients were diagnosed with stage II (36.5%, 38.6%, and 33.5%) or stage III (43.5%, 44.1%, and 55.8%) rectal cancer. There were 43 fewer [95% CI 71 fewer to 18 more] 30-day major complications per 1000 patients undergoing taTME compared to laTME. There were 34 fewer disease recurrences at two years [95% CI 53 fewer to 11 fewer] per 1000 patients undergoing taTME compared to laTME. There were either no clinically important differences or high uncertainty in all outcomes between those undergoing taTME versus roTME for low- and mid-rectal cancer.

Patients with low- and mid-rectal cancer undergoing taTME may confer a lower likelihood of 30-day major complications and disease recurrence at 2 years compared to laTME. Additional comparative studies are needed between taTME and roTME in patients with rectal cancer.