A Meta-analysis of Transanal Endoscopic Microsurgery versus Total Mesorectal Excision in the Treatment of Rectal Cancer

Abstract

Background Transanal endoscopic microsurgery (TEMS) has been suggested as an alternative to total mesorectal excision (TME) in the treatment of early rectal cancers. The extended role of TEMS for higher stage rectal cancers after neoadjuvant therapy is also experimented. The aim of this meta-analysis was to compare the oncological outcomes and report on the evidence-based clinical supremacy of either technique. Methods Medline, Embase, and Cochrane databases were searched for the randomized controlled trials comparing the oncological and perioperative outcomes of TEMS and a radical TME. A local recurrence and postoperative complications were analyzed as primary end points. Intraoperative blood loss, operation time, and duration of hospital stay were compared as secondary end points. Results There was no statistical difference in the local recurrence or postoperative complications with a risk ratio of 1.898 and 0.753 and p-values of 0.296 and 0.306, respectively, for TEMS and TME. A marked statistical significance in favor of TEMS was observed for secondary end points. There was standard difference in means of −4.697, −6.940, and −5.685 with p-values of 0.001, 0.005, and 0.001 for blood loss, operation time, and hospital stay, respectively. Conclusion TEMS procedure is a viable alternative to TME in the treatment of early rectal cancers. An extended role of TEMS after neoadjuvant therapy may also be offered to a selected group of patients. TME surgery remains the standard of care in more advanced rectal cancers.

Radical versus Local Surgical Excision for Early Rectal Cancer: A Systematic Review and Meta-Analysis

“…A recent metaanalysis compared only TME to TEM surgical procedures for the outcome (local recurrence) and found only three RCTs for inclusion. They reported that there was no difference between the two interventions as regards to local recurrence or postoperative complications [ 29 ]. In our metaanalysis we included two of the three RCTs but unfortunately we didn’t find the full manuscript of Chen et al [ 30 ] to extract the data from, so it was not included on our final analysis.…”

MRI-based radiomics to predict neoadjuvant chemoradiotherapy outcomes in locally advanced rectal cancer: A multicenter study

“…With widespread neoadjuvant treatment use, 15–27 % of patients achieve a pathological complete response (pCR), and 60–70 % reach tumour downstaging after neoadjuvant treatment [24] , [25] , [26] . Following neoadjuvant treatment, TEM may play an extended role in carefully selected patients with LARC for active surveillance [8] , [9] . Rutger et al .…”

“…Nevertheless, a high local recurrence rate limits TEM application to LARC patients [6] . Neoadjuvant treatment induces tumour downstaging and reduces local recurrence risk, which is expected to expand TEM use to patients with advanced LARC [7] , [8] , [9] . Patients with a complete or “near” complete response to neoadjuvant treatment followed by TEM could achieve good oncological outcomes and improved quality of life [7] , [10] .…”

Clinical Robotic Surgery Association (India Chapter) and Indian rectal cancer expert group’s practical consensus statements for surgical management of localized and locally advanced rectal cancer

“…Also, one-third had to undergo radical surgery ( 36 ). A 2021 metanalysis of randomized controlled trials of TEMS vs. radical surgery concludes that in T1N0 patients may be offered TEMS, but in locally advanced cases radical surgery remains the mainstay ( 37 ).…”