J Robot Surg. 2025 Jun 8;19(1):276. doi: 10.1007/s11701-025-02460-9.
ABSTRACT
Total mesorectal excision (TME) is the gold standard for rectal cancer surgery. Robotic (RoTME) and transanal (TaTME) approaches have gained popularity, but their comparative effectiveness remains uncertain and previous meta-analysis include many retrospective studies which are prone to biases. This meta-analysis aims to bridge this gap. A systematic review and meta-analysis was conducted following PRISMA guidelines. PubMed, Scopus, Embase, and Web of Science were searched for prospective studies comparing RoTME and TaTME. Meta-analysis was performed using random-effects models. Sensitivity analysis included a “leave-one-out” approach. Subgroup analysis was performed for overweight patients. Five non-randomized prospective studies (n = 1941) were included. RoTME and TaTME had no significant differences regarding operative duration (MD: 27.29, 95% CI -56.18 to 110.76, P = 0.29, I2 = 95%) and comparable hospital stay (MD: 3.12, 95% CI -6.14 to 12.39, P = 0.27, I2 = 98%). Blood loss was similar (MD: -22.70, 95% CI -145.80 to 100.40, P = 0.42, I2 = 89%). Conversion rates favored TaTME (OR: 2.39, 95% CI 0.39 to 14.69, P = 0.04, I2 = 26%) but with a wide confidence interval, limiting significance. Sphincter preservation favored TaTME (OR: 0.44, 95% CI 0.17 to 1.16, P < 0.0001, I2 = 32%), but with wide confidence interval, limiting significance. No significant differences were noted for minor complications (OR: 0.88, P = 0.51, I2 = 37%), major complications (OR: 1.21, P = 0.24, I2 = 7%), anastomotic leakage (OR: 1.35, P = 0.09, I2 = 0%), mortality (OR: 1.15, P = 0.82, I2 = 0%), and morbidity (OR: 1.26, P = 0.75, I2 = 95%). R0 resection was significantly higher in RoTME (OR: 1.70, 95% CI 0.92 to 3.16, P = 0.02, I2 = 0%), but with wide confidence interval limiting its significance. No difference was found in lymph node yield (MD: 1.83, 95% CI -2.57 to 6.24, P = 0.06, I2 = 51%). Sensitivity analysis revealed that excluding specific studies reduced heterogeneity and affected operative duration and anastomotic leakage trends. In the overweight subgroup, only hospital stay was significantly shorter in TaTME (MD: 1.50, 95% CI 1.07 to 1.92, P < 0.00001, I2 = 0%). RoTME and TaTME yield comparable perioperative, postoperative, and short-term oncological outcomes. While the pooled results for conversion rate and sphincter preservation numerically favored TaTME, the confidence intervals crossed the line of no effect, indicating that these differences were not statistically significant. Sensitivity analysis highlighted variability among studies. In overweight patients, TaTME reduced hospital stay, though data were limited. Due to the limited number of identified studies and moderate risk of bias, no recommendations can be made to surgeons, patients and healthcare policy makers. Future large-scale RCTs are needed to clarify long-term outcomes, cost-effectiveness, and functional results and determine superiority of either approach. PROSPERO registration: CRD420250654891.
PMID:40483613 | DOI:10.1007/s11701-025-02460-9
