Meta-analysis of transanal versus laparoscopic total mesorectal excision for rectal cancer: a 'New Health Technology'assessment in South Korea
- 주제(키워드) Key Words , Colorectal neoplasms , Laparoscopic total mesorectal excision , Meta-analysis , Systematic review , Transanal total mesorectal excision
- 주제(기타) Surgery
- 설명문(일반) [Kwon, Sun-Ho; Joo, Yea-Il] Natl Evidence Based Healthcare Collaborating Agcy, Div New Hlth Technol Assessment, Seoul, South Korea; [Kim, Seon Hahn; Lee, Dae Ho; Baek, Jeong-Heum; Chung, Soon Sup; Shin, Ji-Yeon; Eun, Chang Soo; Kim, Nam Kyu] Natl Evidence Based Healthcare Collaborating Agcy, Ta TME Assessment Comm, Seoul, South Korea; [Kim, Seon Hahn] Korea Univ, Coll Med, Anam Hosp, Div Colorectal Surg,Dept Surg, Seoul, South Korea; [Lee, Dae Ho] Univ Ulsan, Coll Med, Asan Med Ctr, Dept Oncol, Seoul, South Korea; [Baek, Jeong-Heum] Gachon Univ, Coll Med, Gil Med Ctr, Div Colon & Rectal Surg,Dept Surg, Incheon, South Korea; [Chung, Soon Sup] Ewha Womans Univ, Coll Med, Dept Gen Surg, Seoul, South Korea; [Shin, Ji-Yeon] Kyungpook Natl Univ, Sch Med, Dept Prevent Med, Daegu, South Korea; [Eun, Chang Soo] Hanyang Univ, Guri Hosp, Dept Internal Med, Guri, South Korea; [Kim, Nam Kyu] Yonsei Univ, Coll Med, Inst Gastroenterol, Dept Surg, 50-1 Yonsei Ro, Seoul 03722, South Korea
- 등재 SCIE, SCOPUS, KCI등재
- OA유형 Green Published, gold
- 발행기관 KOREAN SURGICAL SOCIETY
- 발행년도 2021
- 총서유형 Journal
- URI http://www.dcollection.net/handler/ewha/000000183539
- 본문언어 영어
- Published As http://dx.doi.org/10.4174/astr.2021.101.3.167
- PubMed https://pubmed.ncbi.nlm.nih.gov/34549040
초록/요약
Purpose: Under the South Korea's unique health insurance structure, any new surgical technology must be evaluated first by the government in order to consider whether that particular technology can be applied to patients for further clinical trials as categorized as 'New Health Technology,' then potentially covered by the insurance sometime later. The aim of this meta-analysis was to assess the safety and efficacy of transanal total mesorectal excision (TaTME) for rectal cancer, activated by the National Evidence-based Healthcare Collaborating Agency (NECA) TaTME committee. Methods: We systematically searched Ovid-MEDLINE, Ovid-Embase, Cochrane, and Korean databases (from their inception until August 31, 2019) for studies published that compare TaTME with laparoscopic total mesorectal excision (LaTME). End-points included perioperative and pathological outcomes. Results: Sixteen cohort studies (7 for case-matched studies) were identified, comprising 1,923 patients (938 TaTMEs and 985 LaTMEs). Regarding perioperative outcomes, the conversion rate was significantly lower in TaTME (risk ratio, 0.19; 95% confidence interval, 0.11-0.34; P < 0.001); whereas other perioperative outcomes were similar to LaTME. There were no statistically significant differences in pathological results between the 2 procedures. Conclusion: Our meta-analysis showed comparable results in preoperative and pathologic outcomes between TaTME and LaTME, and indicated the benefit of TaTME with low conversion. Extensive evaluations of well-designed, multicenter randomized controlled trials are required to come to unequivocal conclusions, but the results showed that TaTME is a potentially beneficial technique in some specific cases. This meta-analysis suggests that TaTME can be performed for rectal cancer patients as a 'New Health Technology' endorsed by NECA in South Korea. [Ann Surg Treat Res 2021;101(3):167-180]
more