Short-term outcomes of laparoscopic-assisted transanal vs laparoscopic total mesorectal excision for mid-to-low rectal cancer

Abstract

BACKGROUND

Traditional laparoscopic total mesorectal excision (LaTME) presents challenges in patients with low rectal cancer, including difficult surgical exposure and positive margin risks.

AIM

To compare the short-term outcomes of laparoscopic-assisted transanal total mesorectal excision (TaTME) and LaTME for mid-to-low rectal cancer.

METHODS

A retrospective analysis of 138 patients with rectal cancer was conducted, and they were divided into the TaTME group (n = 66) and the LaTME group (n = 72). Surgical indicators, pathological outcomes, recovery parameters, inflammatory markers, and anal function were compared.

RESULTS

The two groups showed comparable baseline characteristics (P > 0.05). The TaTME group demonstrated superior intraoperative performance with significantly less blood loss (78.4 ± 28.6 mL vs 118.7 ± 35.2 mL, P < 0.001), reduced hemoglobin decrease (18.3 ± 8.7 g/L vs 26.8 ± 12.4 g/L, P = 0.002), and lower vasoactive drug requirement (6.1% vs 15.3%, P = 0.044). Pathologically, TaTME achieved better oncological outcomes including lower circumferential resection margin-positive rate (4.5% vs 13.9%, P = 0.032), higher lymph node harvest (17.8 ± 4.6 vs 15.2 ± 4.1, P = 0.001), and improved complete total mesorectal excision rate (89.4% vs 77.8%, P = 0.048). The TaTME group exhibited accelerated gastrointestinal recovery with shorter times to first flatus (2.1 ± 0.8 days vs 2.8 ± 1.2 days, P = 0.001) and reduced hospital stay (7.8 ± 2.1 days vs 9.4 ± 2.8 days, P = 0.001). Inflammatory markers were significantly lower, including postoperative day 2 interleukin (IL)-6 (42.6 ± 12.8 pg/mL vs 56.3 ± 15.7 pg/mL, P < 0.001) and C-reactive protein peaks (68.4 ± 18.2 mg/L vs 89.7 ± 24.6 mg/L, P < 0.001). Multivariate analysis revealed TaTME as an independent protective factor for good anal function (odds ratio = 0.234, P = 0.003), while tumor distance ≤ 2 cm, elevated IL-6, and neoadjuvant therapy were risk factors. These findings demonstrate TaTME's advantages in surgical safety, oncological quality, postoperative recovery, and functional preservation.

CONCLUSION

TaTME demonstrates superior short-term outcomes in surgical safety, oncological quality, and functional recovery to LaTME, warranting clinical promotion.

Keywords: Rectal cancer; Laparoscopic-assisted transanal total mesorectal excision; Laparoscopic total mesorectal excision; Low rectal cancer; Oncological outcomes; Postoperative recovery

Core Tip: This retrospective study compared laparoscopic-assisted transanal total mesorectal excision (TaTME) with traditional laparoscopic total mesorectal excision in 138 patients with mid-to-low rectal cancer. TaTME demonstrated significant advantages including reduced intraoperative blood loss, superior oncological outcomes with lower circumferential resection margin positivity rates and higher lymph node harvest, accelerated postoperative recovery, attenuated inflammatory response, and better anal function preservation. Multivariate analysis identified TaTME as an independent protective factor for good anal function. These findings suggest TaTME is a safer and more effective surgical approach for mid-to-low rectal cancer, warranting broader clinical adoption.