Evidence map›Paper›PMID 40877625›Full record

SynthesisSurgical endoscopy2025

Outcomes of transanal versus laparoscopic total mesorectal excision for rectal cancer: a meta-analysis and trial sequential analysis of matched cohort studies.

Lei Zhao, Li Li, Dianling Xiao, Xuan Zhang, Jun Ouyang, Xiangheng Chen, Qiulin Huang, Shuai Xiao, Xianhao Yi

Abstract readMeta-AnalysisComparative StudySystematic Review
PubMed Publisher
In one paragraph

Synthesis in Surgical endoscopy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Lei Zhao *Department of Gastrointestinal Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, No.69 Chuanshan Road, Shigu District, Hengyang, 421001, Hunan, China.
Li Li *Department of Gastrointestinal Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, No.69 Chuanshan Road, Shigu District, Hengyang, 421001, Hunan, China.
Dianling XiaoDepartment of Gastrointestinal Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, No.69 Chuanshan Road, Shigu District, Hengyang, 421001, Hunan, China.
Xuan ZhangDepartment of Stomatology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China.
Jun OuyangDepartment of Gastrointestinal Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, No.69 Chuanshan Road, Shigu District, Hengyang, 421001, Hunan, China.
Xiangheng ChenDepartment of Gastrointestinal Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, No.69 Chuanshan Road, Shigu District, Hengyang, 421001, Hunan, China.
Qiulin HuangDepartment of Gastrointestinal Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, No.69 Chuanshan Road, Shigu District, Hengyang, 421001, Hunan, China.
Shuai XiaoDepartment of Gastrointestinal Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, No.69 Chuanshan Road, Shigu District, Hengyang, 421001, Hunan, China.
Xianhao YiDepartment of Gastrointestinal Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, No.69 Chuanshan Road, Shigu District, Hengyang, 421001, Hunan, China. xhyi@usc.edu.cn.ORCID http://orcid.org/0009-0007-1705-7731

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe perioperative and oncological results of laparoscopic total mesorectal excision (laTME) and transanal total mesorectal excision (taTME) have been compared. However, because there are not enough high-quality randomized controlled trials (RCTs), the results cannot be trusted. In order to get more trustworthy results, this article analyzed matched cohort studies.

methodsUntil January 20, 2025, extensive searches were conducted across the Cochrane Library, Web of Science, Embase, and PubMed databases. Using meta-analysis and trial sequential analysis (TSA), we assessed the oncological and perioperative results. Quality assessment was done using the Newcastle-Ottawa Scale. To gauge the overall level of certainty in the evidence, we employed the Grading of Recommendations Assessment, Development, and Evaluation system (GRADE).

results6970 patients from 32 papers were included in the analysis. Comparing the taTME group to the laTME group, the open conversion rate (OR = 0.14, 95% CI = 0.09 to 0.22, P < 0.01), circumferential resection margin (CRM) positivity rate (OR = 0.64, 95% CI = 0.49 to 0.85, P < 0.01), and distal resection margin (DRM) positivity rate (OR = 0.57; 95% CI = 0.36 to 0.89; P = 0.01) were significantly lower. Other perioperative problems and oncological outcomes did not differ. The cumulative Z-curve for CRM positivity rate and open conversion both exceeded the conventional boundary and the trial sequential monitoring border, suggesting strong evidence; however, the DRM positivity rate showed possible false positives. In contrast to the poor CRM and DRM-positive rates, the recommendations for open conversion had a moderate grade.

conclusionBased on matched cohort studies, this meta-analysis shows that taTME may offer advantages in CRM positivity and open conversion rate but shows comparable results for other outcomes. To ascertain whether taTME offers benefits in terms of DRM positively, more investigation is required.

Indexed as

LaparoscopyProctectomyRectal NeoplasmsTransanal Endoscopic SurgeryHumansMargins of ExcisionTreatment OutcomeLaparoscopic total mesorectal excisionMatched cohort studiesMeta-analysisTransanal total mesorectal excisionTrial sequential analysis

Identifiers

PMID40877625

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.