Transanal mesorectal resection has been developed to facilitate minimally invasive proctectomy for rectal cancer.
The purpose of this study was to evaluate the evidence regarding technical parameters, oncological outcomes, morbidity, and mortality after transanal mesorectal resection.
The Cochrane Library, PubMed, and MEDLINE databases were reviewed.
Systematic review of the literature from January 2005 to September 2015 was used for study selection.
Intervention included transanal mesorectal resection for rectal cancer.
Technical parameters, histological outcomes, morbidity, and mortality were the outcomes measured.
Fifteen predominately retrospective studies involving 449 patients were included (mean age, 64.3 years; 64.1% men). Different platforms were used. The operative mortality rate was 0.4% and the cumulative morbidity rate 35.5%. Circumferential resection margins were clear in 98%, and the resected mesorectum was grade III in 87% of patients. Median follow-up was 14.7 months. There were 4 local recurrences (1.5%) and 12 patients (5.6%) with metastatic disease. No study followed patients long enough to report on 5-year overall and disease-free survival rates. Functional outcome was only reported in 3 studies.
A low number of procedures were performed by expert early adopters. There are no comparative or randomized data included in this study and inconsistent reporting of outcome variables.
Transanal mesorectal resection for rectal cancer may enhance negative circumferential margin rates with a reasonable safety profile. Contemporary randomized, controlled studies are required before there can be universal recommendation.
Department of Colorectal Surgery, Castlehill Hospital, Cotttingham, East Yorkshire, United Kingdom
Corresponding author: Shane Killeen, M.D., F.R.C.S., Department of Colorectal Surgery, Castlehill Hospital (CHH), Cottingham, East Yorkshire HU16 5JQ, United Kingdom. firstname.lastname@example.org