Transanal total mesorectal excision for low rectal cancer: a case-matched study comparing TaTME versus standard laparoscopic TME

Mateusz Rubinkiewicz,1 Michał Nowakowski,2 Mateusz Wierdak,1,3 Magdalena Mizera,1 Marcin Dembiński,1 Magdalena Pisarska,1,3 Piotr Major,1,3 Piotr Małczak,1,3 Andrzej Budzyński,1,3 Michał Pędziwiatr1,3 12nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland; 2Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland; 3Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland Background: Transanal total mesorectal excision (TaTME) is emerging as a novel alternative to laparoscopic total mesorectal excision (LaTME). The aim of this study was to compare clinical and pathological results from these two techniques in patients undergoing rectal resections because of low rectal cancer. Materials and methods: Thirty-five patients undergoing TaTME were matched with 35 patients operated on using LaTME. Composite primary endpoint (complete TME, negative circumferential resection margin [pCRM], and distal resection margin [pDRM]) was used to assess pathological quality specimens. Secondary outcomes included operative and postoperative parameters (operative time, total blood loss, postoperative morbidity, length of stay, 30-day mortality). Results: Composite primary endpoint was achieved by 85% of subjects in the TaTME group and 82% of subjects in the LaTME group (P=0.66). Mean pCRM was 1.1±1.29 vs 0.99±0.78 mm (P=0.25). Distal pDRM was 1.57±0.92 and 1.98±1.22 cm (P=0.15). In the TaTME and LaTME groups, respectively, complete mesorectal excision was achieved in 89% and 83% of subjects, while excision was nearly complete for the remaining 11% and 17% (P=0.23). Conclusion: TaTME appears to be a noninferior alternative to laparoscopic surgery. TaTME allows for quality retrieval of surgical specimens with comparable clinical outcomes with LaTME. Keywords: transanal TME, laparoscopic TME, rectal cancer, low rectal cancer, minimally invasive surger

Comparison of totally laparoscopic and open approach in total gastrectomy with D2 lymphadenectomy – systematic review and meta-analysis

Piotr Małczak,1,2 Grzegorz Torbicz,1 Mateusz Rubinkiewicz,1 Natalia Gajewska,1 Nadia Sajuk,1 Kamil Rozmus,1 Michał Wysocki,1,2 Piotr Major,1,2 Andrzej Budzyński,1,2 Michał Pędziwiatr1,2 1Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland; 2Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland Introduction: Gastric cancer is a worldwide health concern, being one of the five most common malignant neoplasms worldwide. Currently, an open approach is the gold standard for surgical treatment. Incorporation of laparoscopy as a method of choice for gastric resections remains controversial because of limited evidence of eligibility. To date, there are no high-quality randomized quality trials on totally laparoscopic D2 total gastrectomies.Aim: The aim of this study was to assess currently available literature and provide meta-analysis on acquired data regarding short-term outcomes with a subgroup analysis of western and eastern studies.Materials and methods: We performed a systematic review and meta-analysis according to the PRISMA guidelines. The primary outcomes of interest were morbidity and short-term complications.Results: An initial reference search yielded 3,073 articles. Finally, we chose eight studies covering 1,582 patients that we included in the quantitative analysis. We did not find statistical differences regarding operative time, anastomotic leakage, surgical site infection, cardiac complications, pulmonary complications, or number of harvested lymph nodes. We found significant differences regarding length of hospital stay and morbidity in the Asian population.Conclusion: This systematic review indicates that a laparoscopic approach for D2 total gastrectomy does not increase morbidity. Furthermore, it allows for a shorter hospital stay. However, more randomized controlled trials are required to fully assess this approach because available data are of limited quality. Keywords: systematic review, meta-analysis, total gastrectomy, laparoscop