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Title: Defining the learning curve of transanal total mesorectal excision: a systematic review and meta-analysis.
Austin Authors: Lau, Steve Yee Chiang;Choy, Kay T ;Yang, Tze Wei Wilson;Heriot, Alexander;Warrier, Satish K;Guest, Glenn D;Kong, Joseph C
Affiliation: Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
Department of Surgery, University Hospital Geelong, Geelong, Victoria, Australia
Department of Surgery, Epworth Geelong Hospital, Deakin University, Geelong, Victoria, Australia
Department of Colorectal Surgery, Alfred Hospital, Melbourne, Victoria, Australia
Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
Issue Date: 22-Oct-2021
Date: 2021-10-22
Publication information: ANZ Journal of Surgery 2022; 92(3): 355-364
Abstract: Transanal total mesorectal excision (taTME) represents a novel approach to rectal dissection. Although many structured training programs have been developed worldwide to assist surgeons in implementing this new technique, the learning curve (LC) of taTME has yet to be conclusively defined. This is particularly important given the concerns regarding the complication profile and oncological safety of taTME. The aim of this review was to provide an up-to-date systematic review and meta-analysis of the LC for taTME, comparing the difference of outcomes between the LC and after learning curve (ALC) groups. An up-to-date systematic review was performed on the available literature between 2010-2020 on PubMed, EMBASE, Medline and Cochrane Library databases. All studies comparing taTME procedures before and after LC were analysed. Seven retrospective studies of prospectively collected databases were included, comparing 333 (51.0%) patients in the LC group and 320 (49.0%) patients in the ALC group. There was a significantly reduced number of adverse intra-operative events, anastomotic leaks and improved quality of mesorectal excision in the ALC group. This review shows that there is a significant improvement in clinical outcomes between the LC and ALC groups which supports the need for careful mastery and ongoing technical refinement during the LC in taTME. This procedure should be performed on a subset of carefully selected patients in the hands of experienced and well-trained teams dedicated to ongoing audit.
DOI: 10.1111/ans.17262
ORCID: 0000-0003-2819-9704
Journal: ANZ Journal of Surgery
PubMed URL: 34676655
Type: Journal Article
Subjects: learning curve
transanal TME
Appears in Collections:Journal articles

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