Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jan 27, 2025; 17(1): 100364
Published online Jan 27, 2025. doi: 10.4240/wjgs.v17.i1.100364
Comparative efficacy analysis of laparoscopic-assisted transanal total mesorectal excision vs laparoscopic transanal mesorectal excision for low-lying rectal cancer
Feng Lu, Shu-Guang Tan, Juan Zuo, Hai-Hua Jiang, Jian-Hua Wang, Yu-Ping Jiang
Feng Lu, Shu-Guang Tan, Hai-Hua Jiang, Jian-Hua Wang, Department of Gastrointestinal Surgery, Affiliated Hengyang Hospital of Hunan Normal University & Hengyang Central Hospital, Hengyang 421001, Hunan Province, China
Juan Zuo, Department of Hematology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang 421001, Hunan Province, China
Yu-Ping Jiang, Department of Gastrointestinal Surgery, Nanhua Hospital Affiliated to University of South China, Hengyang 421002, Hunan Province, China
Author contributions: Lu F designed the research and wrote the first manuscript; Lu F, Tan SG, Zuo J, Jiang HH, Wang JH and Jiang YP contributed to conceiving the research and analyzing data; Lu F and Jiang YP conducted the analysis and provided guidance for the research; all authors reviewed and approved the final manuscript.
Supported by Health Research Project of Hunan Provincial Health Commission, No. D202315018915.
Institutional review board statement: This study was approved by the Ethic Committee of Affiliated Hengyang Hospital of Hunan Normal University & Hengyang Central Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yu-Ping Jiang, MM, Associate Chief Physician, Department of Gastrointestinal Surgery, Nanhua Hospital Affiliated to University of South China, No. 336 Dongfeng South Road, Hengyang 421002, Hunan Province, China. 15200523234@163.com
Received: September 6, 2024
Revised: October 10, 2024
Accepted: October 15, 2024
Published online: January 27, 2025
Processing time: 112 Days and 6.2 Hours
Abstract
BACKGROUND

With the continuous development of laparoscopic techniques in recent years, laparoscopic total mesorectal excision (LapTME) and laparoscopic-assisted transanal total mesorectal excision (TaTME) have gradually become important surgical techniques for treating low-lying rectal cancer (LRC). However, there is still controversy over the efficacy and safety of these two surgical modalities in LRC treatment.

AIM

To compare the efficacy of LapTME vs TaTME in patients with LRC.

METHODS

Ninety-four patients with LRC who visited and were treated at the Affiliated Hengyang Hospital of Hunan Normal University & Hengyang Central Hospital between December 2022 and March 2024 were selected and divided into the LapTME (n = 44) and TaTME (n = 50) groups. Clinical operation indexes, postoperative recovery indicators, and postoperative complications were recorded. The anal resting pressure (ARP), anal maximum systolic pressure (MSP), and maximum tolerated volume (MTV) of the anal canal were also measured. The intestinal function of patients was evaluated by the Memorial Sloan Kettering Cancer Center (MSKCC) bowel function questionnaire. Serum norepinephrine (NE), adrenaline (AD), and cortisol (Cor) levels were measured. The Quality of Life Questionnaire Core 30 (QLQ-C30) was used for quality of life assessment.

RESULTS

Compared with the LapTME group, the surgery time in the TaTME group was longer; intraoperative blood loss was low; time of anal exhaust, first postoperative ambulation, intestinal recovery, and hospital stay were shorter; and the distal incisal margin and specimen lengths were longer. The TaTME group also showed higher ARP, MSP, and MTV values and higher MSKCC and QLQ-C30 scores than the LapTME group 3 months postoperatively. Cor, AD, and NE levels were lower in the TaTME group than those in the LapTME group during recovery.

CONCLUSION

We demonstrated that TaTME better improved anal function, reduced postoperative stress, and accelerated postoperative recovery and, hence, was safer for patients with LRC.

Keywords: Laparoscopic total mesorectal excision; Transanal total mesorectal excision; Low-lying rectal cancer; Quality of life; Stress response

Core Tip: Laparoscopic total mesorectal excision (LapTME) and laparoscopic-assisted transanal total mesorectal excision (TaTME) are important minimally invasive TME procedures for the treatment of low-lying rectal cancer (LRC); however, their specific efficacy and safety are still controversial. Per our findings, although surgery time with TaTME is longer, it ensures better rectal cancer specimen resection and faster postoperative recovery (anal exhaust, first postoperative ambulation, intestinal recovery, and hospital stay) compared with LapTME. Moreover, TaTME is more effective in improving surgical safety, enhancing anal function, and reducing postoperative stress responses. Therefore, TaTME may be a better choice for treating LRC.