• Mateusz Rubinkiewicz, Agata Czerwińska, Piotr Zarzycki, Piotr Małczak, Michał Nowakowski, Piotr Major, Andrzej Budzyński, and Michał Pędziwiatr.
• 2nd Department of General Surgery, Jagiellonian University Medical College, 31-501 Kraków, Poland. mateusz.rubinkieiwcz@uj.edu.pl.
• J Clin Med. 2018 Nov 19; 7 (11).

BackgroundTransanal total mesorectal excision (TaTME) is a new technique that is designed to overcome the limits of the open and laparoscopic approach for rectal resections.ObjectiveThis study is designed to compare TaTME with standard laparoscopic TME (LaTME).MethodsWe searched Medline, Embase, and Scopus databases covering a up to October 2018. Inclusion criteria for study enrolment: (1) study comparing laparoscopic resection of rectal cancer vs. TaTME for rectal malignancy, (2) reporting of overall morbidity, operative time, or major complications.ResultsEleven non-randomized studies were eligible with a total of 778 patients. We found statistical significant differences in regard to major complications in favour of TaTME (RR = 0.55; 95% CI 0.31⁻0.97; p = 0.04). We did not found significant differences regarding overall complications intraoperative adverse effects, operative time, anastomotic leakage, intra-abdominal abscess occurrence, Surgical Site Infection, reoperations, Length of stay, completeness of mesorectal excision, R0 resection rate, number of harvested lymph nodes, circumferential resection margin, and distal resection margin.ConclusionsThis meta-analysis shows benefits of TaTME technique regarding major postoperative complications. Regarding clinicopathological features transanal approach is not superior to LaTME. Currently, the quality of the evidence on benefits of TaTME is low due to lack of randomized controlled trials, which needs to be taken into consideration in further evaluation of the technique. Further evaluation of TaTME require conducting large randomized control trials.

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