Meta-analysis of transanal versus laparoscopic total mesorectal excision for rectal cancer: A 'New Health Technology' assessment in South Korea

Sun Ho Kwon, Yea Il Joo, Seon Hahn Kim, Dae Ho Lee, Jeong Heum Baek, Soon Sup Chung, Ji Yeon Shin, Chang Soo Eun, Nam Kyu Kim

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Purpose: Under the South Korea's unique health insurance structure, any new surgical technology must be evaluated first by the government in order to consider whether that particular technology can be applied to patients for further clinical trials as categorized as 'New Health Technology,' then potentially covered by the insurance sometime later. The aim of this meta-analysis was to assess the safety and efficacy of transanal total mesorectal excision (TaTME) for rectal cancer, activated by the National Evidence-based Healthcare Collaborating Agency (NECA) TaTME committee. Methods: We systematically searched Ovid-MEDLINE, Ovid-Embase, Cochrane, and Korean databases (from their inception until August 31, 2019) for studies published that compare TaTME with laparoscopic total mesorectal excision (LaTME). End-points included perioperative and pathological outcomes. Results: Sixteen cohort studies (7 for case-matched studies) were identified, comprising 1,923 patients (938 TaTMEs and 985 LaTMEs). Regarding perioperative outcomes, the conversion rate was significantly lower in TaTME (risk ratio, 0.19; 95% confidence interval, 0.11-0.34; P < 0.001); whereas other perioperative outcomes were similar to LaTME. There were no statistically significant differences in pathological results between the 2 procedures. Conclusion: Our meta-analysis showed comparable results in preoperative and pathologic outcomes between TaTME and LaTME, and indicated the benefit of TaTME with low conversion. Extensive evaluations of well-designed, multicenter randomized controlled trials are required to come to unequivocal conclusions, but the results showed that TaTME is a potentially beneficial technique in some specific cases. This meta-analysis suggests that TaTME can be performed for rectal cancer patients as a 'New Health Technology' endorsed by NECA in South Korea.

Original languageEnglish
Pages (from-to)167-180
Number of pages14
JournalAnnals of Surgical Treatment and Research
Volume101
Issue number3
DOIs
StatePublished - Sep 2021

Bibliographical note

Publisher Copyright:
© 2021, the Korean Surgical Society.

Keywords

  • Colorectal neoplasms
  • Laparoscopic total mesorectal excision
  • Meta-analysis
  • Systematic review
  • Transanal total mesorectal excision

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