Functional complaints and quality of life after transanal total mesorectal excision: a meta-analysis

J. A.G. van der Heijden, T. Koëter, L. J.H. Smits, C. Sietses, J. B. Tuynman, A. J.G. Maaskant-Braat, B. R. Klarenbeek, J. H.W. de Wilt

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46 Citations (Scopus)


Background: Total mesorectal excision (TME) gives excellent oncological results in rectal cancer treatment, but patients may experience functional problems. A novel approach to performing TME is by single-port transanal minimally invasive surgery. This systematic review evaluated the functional outcomes and quality of life after transanal and laparoscopic TME. Methods: A comprehensive search in PubMed, the Cochrane Library, Embase and the trial registers was conducted in May 2019. PRISMA guidelines were used. Data for meta-analysis were pooled using a random-effects model. Results: A total of 11 660 studies were identified, from which 14 studies and six conference abstracts involving 846 patients (599 transanal TME, 247 laparoscopic TME) were included. A substantial number of patients experienced functional problems consistent with low anterior resection syndrome (LARS). Meta-analysis found no significant difference in major LARS between the two approaches (risk ratio 1·13, 95 per cent c.i. 0·94 to 1·35; P = 0·18). However, major heterogeneity was present in the studies together with poor reporting of functional baseline assessment. Conclusion: No differences in function were observed between transanal and laparoscopic TME.

Original languageEnglish
Pages (from-to)489-498
Number of pages10
JournalBritish Journal of Surgery
Issue number5
Publication statusPublished - 1 Apr 2020

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