TTP2.02 A Systematic Review of taTME vs LaTME on Randomized Controlled Trials

Aims Since the introduction of taTME in 2010, the approach has been increasingly used for the excision of lower rectal cancers. However, studies comparing taTME to LaTME are limited. Our study aimed to compare the two approaches based on evidence from randomized controlled trials (RCTs). Methods We performed a systematic literature search to identify RCTs comparing taTME and LaTME adhering to PRISMA guidelines. Meta analysis was performed using R software (version 4.3.2). Results were synthesized as odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CI), and heterogeneity was assessed using the I² statistic. Risk of bias was assessed using the NIH Quality Assessment Tool for controlled intervention studies. Results Seven RCTs were selected (3801 patients, median age 61 years): 1782 patients underwent taTME and 2019 underwent LaTME. Age, BMI, and disease stage were similar in both groups. Conversion rates were significantly lower for taTME (OD: 0.25, 95% CI: 0.15 to 0.41, p<0.0001, and hospital stay was significantly shorter for taTME (MD: -0.66 days, 95% CI: -1.02 to -0.29, p =0.0004). There was no statistically significant difference for anastomotic leaks (p=0.093) and overall complication rates (p=0.5264). Local recurrence and major complication rates showed no significant differences between the groups (p=0.83; p=0.6746, respectively). Mortality (p=0.4392), operative time (p=0.5609) and reoperation rates (p=0.6437) were not significantly different. Conclusion TaTME was associated with lower conversion rates and shorter hospital stay compared to LaTME. No clinical difference was observed in complication rates, mortality, local recurrence, anastomotic leaks and reoperation rates.