Spin in articles about minimally invasive transanal total mesorectal excision: an assessment of the current literature

Colorectal Dis. 2019 Jan;21(1):8-14. doi: 10.1111/codi.14451. Epub 2018 Nov 26.


Aim: Minimally invasive transanal total mesorectal excision (TaTME) is a new approach for treating rectal cancer. 'Spin' can be defined as 'reporting strategies to highlight that the experimental treatment is beneficial' despite limitations in study design. The aim of this study was to assess spin within publications about TaTME.

Method: EMBASE and MEDLINE (2009-2017) were searched for publications assessing TaTME in rectal cancer. All papers published between 2009 and 2017 were eligible for inclusion. Study titles and abstracts were assessed for evidence of spin, as previously defined.

Results: A total of 1202 studies were identified through our search, and 73 were included. The majority were case series (n = 48, 66%). A total of 55 publications (75%) had evidence of spin within at least one domain. The most common type of spin was claiming safety without describing how this was defined or tested (56%). Other strategies included claiming superiority without support (33%) and reporting nonsignificance as equivalence (42%). We did not find that year of publication (P = 0.61), study design (P = 0.60), number of patients (P = 0.85) or declared conflict of interest (P = 0.43) were associated with spin.

Conclusion: We have shown that spin is common within studies assessing TaTME for rectal cancer. Despite a lack of support from study results, in the majority of studies authors concluded that TaTME is safe for use in rectal cancer. Readers of study abstracts describing new techniques need to be cautious about accepting the authors' conclusions, especially in case series and observational studies.

Keywords: Rectal cancer; minimally invasive surgery; spin; transanal total mesorectal excision.

Publication types

  • Systematic Review

MeSH terms

  • Bias*
  • Conflict of Interest
  • Humans
  • Mesentery / surgery*
  • Proctectomy*
  • Rectal Neoplasms / surgery*
  • Research Design*
  • Transanal Endoscopic Surgery*