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Meta-analysis of transanal versus laparoscopic total mesorectal excision for rectal cancer: a ‘New Health Technology’ assessment in South Korea

Authors
 Sun-Ho Kwon  ;  Yea-Il Joo  ;  Seon Hahn Kim  ;  Dae Ho Lee  ;  Jeong-Heum Baek  ;  Soon Sup Chung  ;  Ji-Yeon Shin  ;  Chang Soo Eun  ;  Nam Kyu Kim 
Citation
 ANNALS OF SURGICAL TREATMENT AND RESEARCH, Vol.101(3) : 167-180, 2021-09 
Journal Title
ANNALS OF SURGICAL TREATMENT AND RESEARCH
ISSN
 2288-6575 
Issue Date
2021-09
Keywords
Colorectal neoplasms ; Laparoscopic total mesorectal excision ; Meta-analysis ; Systematic review ; Transanal total mesorectal excision
Abstract
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.
Files in This Item:
T202103855.pdf Download
DOI
10.4174/astr.2021.101.3.167
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Nam Kyu(김남규) ORCID logo https://orcid.org/0000-0003-0639-5632
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/184840
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