Comparative Outcomes of Transanal vs. Laparoscopic Total Mesorectal Excision in Rectal Cancer

Author(s): Roda Rashid Bin Sultan Alshamsi, Najla Ebrahim Almansoori, Reem Sultan BinTarish Al Mheiri, Maryam Alyas Ali, Reem Ibrahim Ali, Maha Almheiri, Fatima basheer Ali Mohammed Yousuf, Maria Ammari, Masa Murad Fares, Abrar Dhaifallah Alameri

This paper aims to make a meta-analysis and compare the results of two kinds of surgery protocols: transanal total mesorectal excision (taTME) and laparoscopic total mesorectal excision (lapTME) in managing rectal cancer. The main rationale for the study was to compare SSM and OSF for differences in surgical quality, perioperative outcomes, and oncological outcomes to inform clinical preference. Qualitative descriptive statistics and post-hoc sensitivity analyses were employed to investigate CRM infringement, mesorectal excision radicality, operative duration, conversion, complications, and long-term oncological results, including local Recurrence and overall survival. The results suggest that taTME provides benefits in terms of less positive CRM and better mesorectal excision than the lapTME technique, representing improved accuracy of surgery. Moreover, when comparing taTME with oTME, surgeons had shorter operative time and a lower conversion rate to open surgery; it was therefore concluded that taTME was effective in tackling complex cases, including distal lesions or regions of the pelvic anatomy. The perioperative safety of both techniques was found to be similar with regard to intraoperative complications and postoperative mortality and morbidity. No differences occurred in distant or local Recurrence and survival rates, reflecting oncological equity between the two methods. In conclusion, the present study shows that time can be considered a viable approach to lapTME, especially when a higher level of surgery accuracy is needed. This proposal integrates technical advantages that are perfectly balanced with safety and oncological yield, which is why rectal cancer surgery is suitable for this approach. Subsequent high-quality, large-scale studies with longer follow-ups are suggested to confirm the results and enrich the evidence supporting clinical decision-making in rectal cancer treatment.

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