Objective To find individualized evidence-based treatments for a patient with lower rectal cancer. Methods Based on the clinical questions raised, evidence was collected and critically assessed. Patient preferences and physician clinical experience were also taken into consideration in the decision-making treatment. Results Twenty-four systematic reviews or meta analyses and 1 clinical guideline were included. The evidence showed that preoperative chemoradio- therapy reduces risk of local recurrence and death from rectal cancer compared to preoperative radiotherapy alone. Preoperative combined chemoradiotherapy, enhanced pathological response and improved local control in the resectable stage II and III rectal cancer. Preoperative chemoradiotherapy reduced the risk of local recurrence as compared with postoperative chemoradiotherapy. Postoperative radiotherapy alone did not improve survival for the patients with resected stage II and stage III rectal cancer, whereas either chemotherapy alone or combined chemotherapy and radiotherapy improved survival in comparison with observation. As compared with conventional radical surgery, total mesorectum excision (TME) resulted in lower postoperative local recurrence rate and higher survival rate. No significant differences in terms of disease-free survival rate, local recurrence rate, mortality, and morbidity were found between laparoscopic and open total mesorectal excision. Conclusion The patients with lower rectal cancer might benefit from preoperative chemoradiotherapy, postoperative chemotherapy, and chemoradiotherapy. TME is the standard rectal cancer surgery. However, long-term prognostic benefits need to be confirmed by further follow-up.
ObjectiveTo evaluate the short-term clinical outcomes of transanal total mesorectal excision (TaTME) and provide evidence for clinical decision-making. MethodsRelevant literature from domestic and international databases in recent years was reviewed to systematically assess the current application of TaTME in the treatment of mid-to-low rectal cancer. A comparative analysis was conducted between TaTME and laparoscopic TME (LapTME), focusing on intraoperative outcomes, short-term postoperative recovery, intraoperative and postoperative complications, oncological prognosis, and the learning curve. ResultsConventional LapTME presents significant challenges in performing precise maneuvers within the pelvis and around the rectum, particularly in patients with "difficult pelvis" characteristics such as obesity, narrow pelvis, or male anatomy. In contrast, TaTME demonstrates certain advantages, including improved visualization of anatomical planes, reduced intraoperative bleeding, lower conversion rates to open surgery, faster short-term postoperative recovery, and enhanced specimen quality. ConclusionTaTME is a safe procedure with short-term outcomes that are superior or comparable to those of laparoscopic surgery, offering a new surgical option for the treatment of low rectal cancer.