Comparison of surgical quality and long-term outcome between hybrid trans-anal total meso-rectal excision and laparoscopic total meso-rectal excision: a systematic review and meta-analysis

BACKGROUND Laparoscopy-assisted trans-anal TME (ta-TME), or hybrid ta-TME, inherited the advantages of both trans-anal surgery and trans-abdominal surgery, and is gaining increasing acceptance from colorectal surgeons worldwide. This research aims to make a comprehensive comparison between hybrid ta-TME surgery and traditional laparoscopic TME (la-TME) surgery regarding surgical quality and long-term survival. METHODS Cochrane Library, EMbase, Web of Science and PubMed were searched for studies comparing hybrid ta-TME with traditional la-TME. Indicators for surgical quality and long-term prognosis were extracted and pooled. Heterogeneity was assessed with I2 index and was significant when p<0.1 and I2>50%. Publication bias was estimated by Egger test, where p<0.1 was considered statistically significant. RESULTS 13 studies with 992 patients were included in meta-analysis, of which 467 were in hybrid ta-TME cohorts, and 525 were in traditional la-TME cohorts. Compared with traditional la-TME, hybrid ta-TME has lower rate of positive circumferential margin (RR=0.454, 95%CI 0.240~0.862, p=0.016) and lower conversion rate (RR=0.336, 95%CI 0.134~0.844, p=0.020). On rate of positive distal resection margin, completeness/near-completeness of meso-rectum, overall complications, anal leakage, ileus, urinary dysfunction, 2-year DFS and 2-year OS, there were no significant difference between the two techniques. CONCLUSIONS Hybrid ta-TME is significantly superior to traditional la-TME in ensuring CRM safety and lowering intra-operative conversion rate, and is meanwhile not inferior on other major outcome indicators concerning surgical quality and long-term survival. To further understand this new surgical technique, we need high-quality RCTs, as well as previous researchers updates with results of prolonged follow-up.

Constipation: Medical and Surgical Treatment

This review follows the general review entitled “Constipation,” which introduced the definition, classification, epidemiology, etiology, clinical evaluation, and investigation of constipation. This review addresses the medical and surgical management of constipation with a focus on surgical management. The latter is a subject of much controversy, and this review aims to provide a balanced view between those who favor radical surgery for the colon (colectomy) and rectum/pelvic floor (forms of rectopexy, rectal excision, and reinforcement) and those who have concerns that the unpredictable outcomes of such procedures push the risk–benefit analysis against surgical intervention for most patients. This review contains 5 figures, 2 tables and 80 references Key Words: chronic constipation, colectomy, constipation, ileorectal, intussusception, pelvic floor, rectocele, rectocele repair, rectopexy, slow-transit, stapled transanal rectal resection