Short-term outcomes of laparoscopic-assisted transanal vs laparoscopic total mesorectal excision for mid-to-low...

Traditional laparoscopic total mesorectal excision (LaTME) presents challenges in patients with low rectal cancer, including difficult surgical exposure and positive margin risks.

To compare the short-term outcomes of laparoscopic-assisted transanal total mesorectal excision (TaTME) and LaTME for mid-to-low rectal cancer.

A retrospective analysis of 138 patients with rectal cancer was conducted, and they were divided into the TaTME group (n = 66) and the LaTME group (n = 72). Surgical indicators, pathological outcomes, recovery parameters, inflammatory markers, and anal function were compared.

The two groups showed comparable baseline characteristics (P > 0.05). The TaTME group demonstrated superior intraoperative performance with significantly less blood loss (78.4 ± 28.6 mL vs 118.7 ± 35.2 mL, P < 0.001), reduced hemoglobin decrease (18.3 ± 8.7 g/L vs 26.8 ± 12.4 g/L, P = 0.002), and lower vasoactive drug requirement (6.1% vs 15.3%, P = 0.044). Pathologically, TaTME achieved better oncological outcomes including lower circumferential resection margin-positive rate (4.5% vs 13.9%, P = 0.032), higher lymph node harvest (17.8 ± 4.6 vs 15.2 ± 4.1, P = 0.001), and improved complete total mesorectal excision rate (89.4% vs 77.8%, P = 0.048). The TaTME group exhibited accelerated gastrointestinal recovery with shorter times to first flatus (2.1 ± 0.8 days vs 2.8 ± 1.2 days, P = 0.001) and reduced hospital stay (7.8 ± 2.1 days vs 9.4 ± 2.8 days, P = 0.001). Inflammatory markers were significantly lower, including postoperative day 2 interleukin (IL)-6 (42.6 ± 12.8 pg/mL vs 56.3 ± 15.7 pg/mL, P < 0.001) and C-reactive protein peaks (68.4 ± 18.2 mg/L vs 89.7 ± 24.6 mg/L, P < 0.001). Multivariate analysis revealed TaTME as an independent protective factor for good anal function (odds ratio = 0.234, P = 0.003), while tumor distance ≤ 2 cm, elevated IL-6, and neoadjuvant therapy were risk factors. These findings demonstrate TaTME's advantages in surgical safety, oncological quality, postoperative recovery, and functional preservation.

TaTME demonstrates superior short-term outcomes in surgical safety, oncological quality, and functional recovery to LaTME, warranting clinical promotion.