TY - JOUR
T1 - Functional outcomes and quality of life following open versus laparoscopic versus robot-assisted versus transanal total mesorectal excision in rectal cancer patients
T2 - a systematic review and meta-analysis
AU - The MIRECA Study Group
AU - Geitenbeek, Ritch T.J.
AU - Burghgraef, Thijs A.
AU - Moes, Carmen A.
AU - Hompes, Roel
AU - Ranchor, Adelita V.
AU - Consten, Esther C.J.
AU - van Acker, G. J.D.
AU - Aukema, T. S.
AU - Belgers, H. J.
AU - Beverdam, F. H.
AU - Bloemen, J. G.
AU - Bosscha, K.
AU - Breukink, S. O.
AU - Coene, P. P.L.O.
AU - Crolla, R. M.P.H.
AU - van Duijvendijk, P.
AU - van Duyn, E. B.
AU - Faneyte, I. F.
AU - Fransen, S. A.F.
AU - van Geloven, A. A.W.
AU - Gerhards, M. F.
AU - van Grevenstein, W. M.U.
AU - Havenga, K.
AU - de Hingh, I. H.J.T.
AU - Hoff, C.
AU - Kats, G.
AU - Leijtens, J. W.A.
AU - Holzik, M. F.Lutke
AU - Melenhorst, J.
AU - Poelman, M. M.
AU - Pronk, A.
AU - Schiphorst, A. H.W.
AU - Schreinemakers, J. M.J.
AU - Sietses, C.
AU - Smits, A. B.
AU - Somers, I.
AU - Spillenaar-Bilgen, E. J.
AU - Stockmann, H. B.A.C.
AU - Talsma, A. K.
AU - Tanis, P. J.
AU - Tuynman, J.
AU - Verdaasdonk, E. G.G.
AU - Warmerdam, F. A.R.M.
AU - van Westreenen, H. L.
AU - Zimmerman, D. D.E.
N1 - Publisher Copyright:
© The Author(s) 2024.
PY - 2024/8
Y1 - 2024/8
N2 - Background: The standard surgical treatment for rectal cancer is total mesorectal excision (TME), which may negatively affect patients’ functional outcomes and quality of life (QoL). However, it is unclear how different TME techniques may impact patients’ functional outcomes and QoL. This systematic review and meta-analysis evaluated functional outcomes of urinary, sexual, and fecal functioning as well as QoL after open, laparoscopic (L-TME), robot-assisted (R-TME), and transanal total mesorectal excision (TaTME). Methods: A systematic review and meta-analysis, based on the preferred reporting items for systematic reviews and meta-analysis statement, were conducted (PROSPERO: CRD42021240851). A literature review was performed (sources: PubMed, Medline, Embase, Scopus, Web of Science, and Cochrane Library databases; end-of-search date: September 1, 2023), and a quality assessment was performed using the Methodological index for non-randomized studies. A random-effects model was used to pool the data for the meta-analyses. Results: Nineteen studies were included, reporting on 2495 patients (88 open, 1171 L-TME, 995 R-TME, and 241 TaTME). Quantitative analyses comparing L-TME vs. R-TME showed no significant differences regarding urinary and sexual functioning, except for urinary function at three months post-surgery, which favoured R-TME (SMD [CI] –0.15 [− 0.24 to − 0.06], p = 0.02; n = 401). Qualitative analyses identified most studies did not find significant differences in urinary, sexual, and fecal functioning and QoL between different techniques. Conclusions: This systematic review and meta-analysis highlight a significant gap in the literature concerning the evaluation of functional outcomes and QoL after TME for rectal cancer treatment. This study emphasizes the need for high-quality, randomized-controlled, and prospective cohort studies evaluating these outcomes. Based on the limited available evidence, this systematic review and meta-analysis suggests no significant differences in patients' urinary, sexual, and fecal functioning and their QoL across various TME techniques.
AB - Background: The standard surgical treatment for rectal cancer is total mesorectal excision (TME), which may negatively affect patients’ functional outcomes and quality of life (QoL). However, it is unclear how different TME techniques may impact patients’ functional outcomes and QoL. This systematic review and meta-analysis evaluated functional outcomes of urinary, sexual, and fecal functioning as well as QoL after open, laparoscopic (L-TME), robot-assisted (R-TME), and transanal total mesorectal excision (TaTME). Methods: A systematic review and meta-analysis, based on the preferred reporting items for systematic reviews and meta-analysis statement, were conducted (PROSPERO: CRD42021240851). A literature review was performed (sources: PubMed, Medline, Embase, Scopus, Web of Science, and Cochrane Library databases; end-of-search date: September 1, 2023), and a quality assessment was performed using the Methodological index for non-randomized studies. A random-effects model was used to pool the data for the meta-analyses. Results: Nineteen studies were included, reporting on 2495 patients (88 open, 1171 L-TME, 995 R-TME, and 241 TaTME). Quantitative analyses comparing L-TME vs. R-TME showed no significant differences regarding urinary and sexual functioning, except for urinary function at three months post-surgery, which favoured R-TME (SMD [CI] –0.15 [− 0.24 to − 0.06], p = 0.02; n = 401). Qualitative analyses identified most studies did not find significant differences in urinary, sexual, and fecal functioning and QoL between different techniques. Conclusions: This systematic review and meta-analysis highlight a significant gap in the literature concerning the evaluation of functional outcomes and QoL after TME for rectal cancer treatment. This study emphasizes the need for high-quality, randomized-controlled, and prospective cohort studies evaluating these outcomes. Based on the limited available evidence, this systematic review and meta-analysis suggests no significant differences in patients' urinary, sexual, and fecal functioning and their QoL across various TME techniques.
KW - Functional outcomes
KW - Meta-analysis
KW - Quality of life
KW - Rectal cancer
KW - Systematic review
KW - Total mesorectal excision
KW - Humans
KW - Laparoscopy
KW - Postoperative Complications
KW - Proctectomy
KW - Rectal Neoplasms
KW - Robotic Surgical Procedures
KW - Transanal Endoscopic Surgery
KW - Treatment Outcome
KW - American Society of Anaesthesiologists score
KW - Article
KW - Cochrane Library
KW - controlled study
KW - Embase
KW - European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30
KW - follow up
KW - global health
KW - GRADE approach
KW - human
KW - International Index of Erectile Function
KW - laparoscopic total mesorectal excision
KW - Medline
KW - meta analysis
KW - outcome assessment
KW - Preferred Reporting Items for Systematic Reviews and Meta-Analyses
KW - qualitative analysis
KW - quality control
KW - quantitative analysis
KW - rectum cancer
KW - robot assisted surgery
KW - Scopus
KW - sexual function
KW - sexuality
KW - social well-being
KW - transanal total mesorectal excision
KW - Web of Science
KW - comparative study
KW - epidemiology
KW - etiology
KW - postoperative complication
KW - procedures
KW - rectum tumor
KW - surgery
UR - https://www.scopus.com/pages/publications/85196372962
U2 - 10.1007/s00464-024-10934-4
DO - 10.1007/s00464-024-10934-4
M3 - Article
C2 - 38898341
AN - SCOPUS:85196372962
SN - 0930-2794
VL - 38
SP - 4431
EP - 4444
JO - Surgical endoscopy
JF - Surgical endoscopy
IS - 8
ER -
