UEG and EAES rapid guideline: Systematic review, meta-analysis, GRADE assessment and evidence-informed European recommendations on TaTME for rectal cancer

• Published in: Surgical endoscopy Vol. 36; no. 4; pp. 2221 - 2232
• Main Authors: Milone, Marco, Adamina, Michel, Arezzo, Alberto, Bejinariu, Nona, Boni, Luigi, Bouvy, Nicole, de Lacy, F Borja, Dresen, Raphaëla, Ferentinos, Konstantinos, Francis, Nader K., Mahaffey, Joe, Penna, Marta, Theodoropoulos, George, Kontouli, Katerina Maria, Mavridis, Dimitris, Vandvik, Per Olav, Antoniou, Stavros A.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.04.2022; Springer Nature B.V
• Subjects: Abdominal Surgery; Clinical practice guidelines; Colorectal cancer; Dissection; Endoscopy; Gastroenterology; GRADE Approach; Guidelines; Gynecology; Hepatology; Humans; Laparoscopy; Laparoscopy - methods; Medicine; Medicine & Public Health; Meta-analysis; Mortality; Patients; Postoperative Complications - surgery; Proctectomy; Proctology; Quality of life; Radiation; Rectal Neoplasms - surgery; Rectum; Rectum - surgery; Robotic surgery; Surgery; Systematic review; Transanal Endoscopic Surgery - methods; Transanal TME; GRADE; TaTME; EAES; Rectal cancer; Clinical practice guideline
• ISSN: 0930-2794; 1432-2218; 1432-2218
• DOI: 10.1007/s00464-022-09090-4

Background Evidence and practice recommendations on the use of transanal total mesorectal excision (TaTME) for rectal cancer are conflicting. Objective We aimed to summarize best evidence and develop a rapid guideline using transparent, trustworthy, and standardized methodology. Methods We developed a rapid guideline in accordance with GRADE, G-I-N, and AGREE II standards. The steering group consisted of general surgeons, members of the EAES Research Committee/Guidelines Subcommittee with expertise and experience in guideline development, advanced medical statistics and evidence synthesis, biostatisticians, and a guideline methodologist. The guideline panel consisted of four general surgeons practicing colorectal surgery, a radiologist with expertise in rectal cancer, a radiation oncologist, a pathologist, and a patient representative. We conducted a systematic review and the results of evidence synthesis by means of meta-analyses were summarized in evidence tables. Recommendations were authored and published through an online authoring and publication platform (MAGICapp), with the guideline panel making use of an evidence-to-decision framework and a Delphi process to arrive at consensus. Results This rapid guideline provides a weak recommendation for the use of TaTME over laparoscopic or robotic TME for low rectal cancer when expertise is available. Furthermore, it details evidence gaps to be addressed by future research and discusses policy considerations. The guideline, with recommendations, evidence summaries, and decision aids in user-friendly formats can also be accessed in MAGICapp: https://app.magicapp.org/#/guideline/4494 . Conclusions This rapid guideline provides evidence-informed trustworthy recommendations on the use of TaTME for rectal cancer.