Retrospective Study Comparing Prognosis and Anorectal Function Outcomes Between Laparoscopic and Transanal Total Mesorectal Excision in Middle- and Low-Rectal Cancer
Introduction: Colorectal cancer (CRC), particularly rectal cancer, remains a significant global health issue, with low- and middle-rectal cancers making up a large proportion of cases. Surgical resection through total mesorectal excision (TME) is the standard treatment for rectal cancer, with various approaches including laparoscopic (LaTME) and transanal (TaTME) techniques. LaTME has long been considered a reliable method for middle- and low-rectal cancer, offering favorable oncological outcomes with minimal invasiveness. However, challenges remain in obtaining clear distal resection margins and ensuring anal preservation, especially for tumors located near the anus. This study aimed to compare prognostic outcomes and anorectal function between laparoscopic total mesorectal excision (LaTME) and transanal total mesorectal excision (TaTME) in patients with middle- and low-rectal cancer.
Methods: A retrospective analysis was conducted on data from rectal cancer patients in our medical group between January 2018 and December 2022. Differences in prognosis and anorectal function between LaTME and TaTME were evaluated. The primary endpoint was the 2-year overall survival (OS) rate, while secondary endpoints included the 2-year disease-free survival (DFS) rate, 2-year local recurrence rate, and low anterior resection syndrome (LARS) score.
Results: A total of 156 patients were included in the final analysis, with 91 undergoing LaTME and 65 undergoing TaTME. The 2-year OS rates were 86.8% in the LaTME group and 86.2% in the TaTME group. The DFS rates were 75.8% and 73.8%, respectively; the 2-year local recurrence rates were 1.1% and 1.58%; and the 2-year cancer-specific mortality rates were 8.8% and 10.8%, respectively. There were no statistically significant differences between the two surgical approaches. The mean LARS score was 17.13 ± 8.70 in the LaTME group and 18.98 ± 9.05 in the TaTME group, with no statistically significant difference (t (134.72) = –1.28, p = 0.20; 95% confidence interval: –4.71–1.01).
Conclusion: There were no statistically significant differences between TaTME and LaTME in terms of 2-year OS, 2-year DFS, or local recurrence rate. Although the TaTME group had a slightly higher LARS score, the difference was not statistically significant.
- Aneel B, Ana M-B, Gaetano G, et al., European Society of Coloproctology collaborating group. An international multicentre prospective audit of elective rectal cancer surgery: Operative approach versus outcome, including transanal total mesorectal excision (TaTME). Colorectal Dis. 2018;20(Suppl 6):33-46. doi:10.1111/codi.14376
- Ren J, Liu S, Luo H, et al. Comparison of short-term efficacy of transanal total mesorectal excision and laparoscopic total mesorectal excision in low rectal cancer. Asian J Surg. 2021;44(1):181-185. doi:10.1016/j.asjsur.2020.05.007
- Melstrom KA, Kaiser AM. Role of minimally invasive surgery for rectal cancer. World J Gastroenterol. 2020;26(30):4394-4414. doi:10.3748/wjg.v26.i30.4394
- Veltcamp Helbach M, Koedam TWA, Knol JJ, et al. Quality of life after rectal cancer surgery: differences between laparoscopic and transanal total mesorectal excision. Surg Endosc. 2019;33(1):79-87. doi:10.1007/s00464-018-6276-z
- Bademler S, Koza KB, Ucuncu MZ, et al. Standardized laparoscopic sphincter-preserving total mesorectal excision for rectal cancer: median of 10 years' long-term oncologic outcome in 217 unselected consecutive patients. Surg Laparosc Endosc Percutan Tech. 2019;29(5):354-361. doi:10.1097/SLE.0000000000000664
- Liu H, Zeng Z, Zhang H, et al. Morbidity, mortality, and pathologic outcomes of transanal versus laparoscopic total mesorectal excision for rectal cancer: short-term outcomes from a multicenter randomized controlled trial. Ann Surg. 2023;277(1):1-6. doi:10.1097/SLA.0000000000005523
- Pedziwiatr M, Malczak P, Mizera M, et al. There is no difference in outcome between laparoscopic and open surgery for rectal cancer: a systematic review and meta-analysis on short- and long-term oncologic outcomes. Tech Coloproctol. 2017;21(8):595-604. doi:10.1007/s10151-017-1662-4
- Trepanier JS, Lacy FB, Lacy AM. Transanal total mesorectal excision: description of the technique. Clin Colon Rectal Surg. 2020;33(3):144-149. doi:10.1055/s-0039-3402777
- Aubert M, Mege D, Panis Y, et al. Total mesorectal excision for low and middle rectal cancer: Laparoscopic versus transanal approach—a meta-analysis. Surg Endosc. 2020;34(9):3908-3919. doi:10.1007/s00464-019-07160-8
- Seow W, Dudi-Venkata NN, Bedrikovetski S, et al. Outcomes of open vs laparoscopic vs robotic vs transanal total mesorectal excision (TME) for rectal cancer: a network meta-analysis. Tech Coloproctol. 2023;27(5):345-360. doi:10.1007/s10151-022-02739-1
- Filips A, Haltmeier T, Kohler A, et al. LARS is associated with lower anastomoses but not with the transanal approach in patients undergoing rectal cancer resection. World J Surg. 2021;45(3):873-879. doi:10.1007/s00268-020-05876-6
- Yi Chi Z, Gang O, Xiao Li F, et al. Laparoscopic total mesorectal excision versus transanal total mesorectal excision for mid and low rectal cancer: a systematic review and meta-analysis. Medicine (Baltimore). 2024;103(4):e36859. doi:10.1097/MD.0000000000036859
- Emmertsen KJ, Laurberg S. Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg. 2012;255(5):922-928. doi:10.1097/SLA.0b013e31824f1c21
- Rennie O, Sharma M, Helwa N, et al. Colorectal anastomotic leakage: a narrative review of definitions, grading systems, and consequences of leaks. Front Surg. 2024;11:1371567. doi:10.3389/fsurg.2024.1371567
- Feng Q, Yuan W, Li T, et al. Robotic versus laparoscopic surgery for middle and low rectal cancer (REAL): short-term outcomes of a multicentre randomised controlled trial. Lancet Gastroenterol Hepatol. 2022;7(11):991-1004. doi:10.1016/S2468-1253(22)00248-5
- Luvisetto F, Shamali A, Rutgers MLW, et al. Sphincter preservation in patients with low rectal cancer: striking the right oncological balance. Discov Oncol. 2021;12(1):7. doi:10.1007/s12672-021-00400-1
- Bjoern MX, Perdawood SK. Manometric assessment of anorectal function after transanal total mesorectal excision. Tech Coloproctol. 2020;24(3):231-236. doi:10.1007/s10151-020-02147-3
- Lopez-Sanchez A, Morandeira-Rivas A, Moreno-Sanz C, et al. Long-term anorectal manometry outcomes after laparoscopic and transanal total mesorectal excision. J Laparoendosc Adv Surg Tech A. 2021;31(4):395-401. doi:10.1089/lap.2020.1005
- Re AD, Tooza S, Diab J, et al. Outcomes following anastomotic leak from rectal resections, including bowel function and quality of life. Ann Coloproctol. 2023;39(5):395-401. doi:10.3393/ac.2022.00073.0010
- Alimova I, Chernyshov S, Nagudov M, et al. Comparison of oncological and functional outcomes and quality of life after transanal or laparoscopic total mesorectal excision for rectal cancer: a systematic review and meta-analysis. Tech Coloproctol. 2021;25(8):901-913. doi:10.1007/s10151-021-02420-z
- Neary E, Ibrahim T, Verschoor CP, et al. A systematic review and meta-analysis of oncological outcomes with transanal total mesorectal excision for rectal cancer. Colorectal Dis. 2024;26(5):837–850. doi:10.1111/codi.16982
- Bjoern MX, Nielsen S, Perdawood SK, et al. Quality of life after surgery for rectal cancer: a comparison of functional outcomes after transanal and laparoscopic approaches. J Gastrointest Surg. 2019;23(8):1623-1630. doi:10.1007/s11605-018-4057-6
- Yuan Y, Gao Q, Yang H, et al. The efficacy of retrograde and antegrade enemas in the management of low anterior resection syndrome in patients undergoing rectal resection: a systematic review and meta-analysis. BMC Gastroenterol. 2025;25(1):401. doi:10.1186/s12876-025-03985-x
- Rosen H, Sebesta CG, Sebesta C, et al. Management of low anterior resection syndrome (LARS) following resection for rectal cancer. Cancers (Basel). 2023;15(3):778. doi:10.3390/cancers15030778
- Lauricella S, Brucchi F, Carrano FM, et al. Quality of life and functional outcomes after laparoscopic total mesorectal excision (LaTME) and transanal total mesorectal excision (taTME) for rectal cancer: an updated meta-analysis. Int J Colorectal Dis. 2024;39(1):129. doi:10.1007/s00384-024-04703-x
- Zeng Z, Luo S, Zhang H, et al. Transanal vs laparoscopic total mesorectal excision and 3-year disease-free survival in rectal cancer: the TaLaR randomized clinical trial. JAMA. 2025;333(9):774-783. doi:10.1001/jama.2024.24276
- Roodbeen SX, Penna M, van Dieren S, et al. Local recurrence and disease-free survival after transanal total mesorectal excision: results from the international TaTME registry. J Natl Compr Canc Netw. 2021;19(11):1232–1240. doi:10.6004/jnccn.2021.7012