Endoscopic management versus transanal surgery for early primary or early locally recurrent rectal neoplasms—a systematic review and meta-analysis

Abstract

Background Both endoscopic techniques and transanal surgery are viable options that allow organ preservation for early rectal neoplasms. Whilst endoscopic approaches are less invasive and carry less morbidity, it is unclear whether they are as oncologically effective. Aim To compare endoscopic techniques with transanal surgery in the management of early rectal neoplasms. Methods A systematic literature search was performed for randomised and observational studies comparing these techniques. The pre-specified main outcomes measured were en bloc and R0 resection rates and recurrence. Pair-wise meta-analysis was performed. Results This review included 1044 patients. Transanal surgery had increased R0 resection rates (odds ratio (OR) 2.66; 95% CI 1.64; 4.31; p < 0.001) versus endoscopic management. The latter was associated with higher rates of incomplete resection (OR 2.25; 95% CI 1.14, 4.46; p = 0.02) and further intervention (OR 1.78; 95% CI 1.09, 2.88; p = 0.02). There was no difference in the rates of late recurrence (OR 1.01; 95% CI 0.53, 1.91; p = 0.99) or further major surgery (OR 0.87; 95% CI 0.39, 1.94; p = 0.73) between the groups. Endoscopic treatment was associated with a shorter operating time (weighted mean difference (WMD) − 12.08; 95% CI − 18.97, − 5.19; p < 0.001) and LOS (WMD − 1.94; 95% CI − 2.43, − 1.44; p < 0.001), as well as lower rates of urinary retention post-operatively (OR 0.12; 95% CI 0.02, 0.63; p = 0.01). Conclusion Endoscopic techniques should be favoured in the setting of benign early rectal neoplasms given their decreased morbidity and increased cost-effectiveness. However, where malignancy is suspected transanal surgery should be the preferred option given the superior R0 resection rate.

Endoscopic submucosal dissection for rectal neoplastic lesions: experience from a European center.

“…Even though the cutoff point indicated in the ROC analysis in our study was 3.5cm, we achieved a relatively high overall en bloc resection rate (92.5%). Our results are comparative to outcomes of ESD rectal procedures reported in meta-analysis by AP Naughton et al [30].…”

Comparing Endoscopy and Surgery: A Systematic Review of Early Colorectal Cancer Treatments

“…This has led to a notable shift in the surgical approach to these conditions. In fact, Ailish et al, (2020) [12] emphasize the growing preference for endoscopic techniques in benign cases and transanal surgery in suspected malignancies. This is supported by the superior R0 resection rate achieved through transanal surgery.…”

“…The key finding in Ailish et al, 2020 [12] systematic literature review and metanalysis is that transanal surgery has a greater R0 resection rate when compared to endoscopic resection. However, it should be noted that there was no difference in the en bloc resection rate [12].…”

“…Because of its limited invasiveness, TEMS has been promoted as the preferable local excision technique for treating early lower rectal cancer [11]. It entails using specialized devices such as an operating proctoscope, laparoscopic camera, and laparoscopic instruments, which allow the operator to access lesions in the mid and upper rectum [12].…”

Meta-analysis of clinical efficacy and safety of transanal endoscopic microsurgery and endoscopic submucosal dissection in the treatment of rectal tumors

“…The classic endoscopic treatment method is endoscopic submucosal dissection (ESD), which has the advantages of a large resection range and low recurrence rate. However, there are many intraoperative complications and technical difficulties [2]. In recent years, transanal endoscopic microsurgery (TEM) has been widely used as an emerging endoscopic treatment method in the early treatment Meta-analysis of clinical efficacy and safety of transanal endoscopic microsurgery and endoscopic submucosal dissection in the treatment of rectal tumors of rectal tumors [3].…”