A Meta-analysis Of The Efficacy Of Transanal Total Mesorectal Surgery(Tatme) And Laparoscopic Total Mesorectal Excision(L-TME) In The Treatment Of Low And Middle Rectal Cancer

Objective: To conduct a meta-analysis of the short-term and long-term effects of transanal total mesorectal excision(taTME)and laparoscopic total mesorectal excision(L-TME)in the treatment of middle and low rectal cancer.Method: By searching Chinese Journal Full-text Database(CNKI),Wanfang Database,Chinese Biomedical Literature Database(CBM)and English databases PubMed,EMbase,Cochrane Library,to collect the publicly published taTME from January 2015 to December 2019 Literatures comparing the long-term and short-term effects of L-TME.Two surgeons independently conducted literature screening and data extraction and literature quality evaluation.The Newcastle Ottawa Scale(NOS)was used to evaluate the quality of these documents.Use Stata 14.0 statistical software to analyze the operation time,intraoperative blood loss,conversion laparotomy rate,preventive stoma rate,overall postoperative complication rate,anastomotic leakage fistula rate,hospitalization time,completeness of mesenteric tumor resection Meta-analysis was performed on the positive rate of the peripheral margin,the number of lymph nodes acquired,the total recurrence rate,and the2-year overall survival(OS).Results: A total of 18 correlation studies were included,including 1633 patients with rectal cancer,including 807 in the taTME group and 826 in the L-TME group.The quality assessment score of all included studies was> 6 points.Compared with the L-TME group,the taTME group had less surgery time(SMD =-0.37,95% CI:-0.47~-0.26,P=0.000<0.05)and hospital stay(SMD =-0.43,95% CI:-0.67~-0.19,P=0.000<0.05),lower overall postoperative complication rate(OR = 0.64,95% CI:0.47~0.88,P=0.005<0.05),and the completeness of mesenteric tumor resection was higher(OR = 0.48,95% CI = 0.33 ~ 0.69,P=0.000<0.05),the positive rate of circumcision margin was lower(OR = 0.35,95% CI = 0.18~0.66,P=0.001<0.05),and the incidence of preventive stoma was lower(OR = 0.61,95% CI: 0.43~0.88,P=0.008<0.05),the rate of transit laparotomy was lower(OR = 0.11,95% CI: 0.03~0.35,P=0.000<0.05).There was no statistically significant difference between thetwo groups in the amount of intraoperative blood loss,the incidence of anastomotic leakage,the distance of the tumor's distal margin,the number of lymph nodes acquired,the total recurrence rate,and the 2-year overall survival OS.Conclusion:Compared with L-TME,taTME has certain advantages in the short-term treatment of low and middle rectal cancer.TaTME can shorten the operation time and hospitalization time,the rate of transit laparotomy and preventive stoma is lower,and the overall postoperative complications The incidence of the disease is lower,the completeness of the mesenteric tumor of the specimen obtained is higher,and the positive rate of the peripheral margin is lower.