Long‐term outcomes of endoscopic submucosal dissection and transanal endoscopic microsurgery for the treatment of rectal tumors

Abstract

Background and Aim Endoscopic submucosal dissection and transanal endoscopic microsurgery are good options for the treatment of rectal adenomas and early rectal carcinomas, but whether long‐term outcomes of these procedures are comparable is not known. The aim of this study was to address this question. Methods A retrospective single‐center study evaluating 98 consecutive procedures between June 2008 and December 2017 was performed in a tertiary cancer center. Consecutive patients who had undergone either endoscopic submucosal resection or transanal endoscopic microsurgery for rectal adenomas and early rectal carcinomas were evaluated, and long‐term recurrence and complication rates were compared. Results Both groups were similar regarding sex, age, preoperative surgical risk, and en bloc resection rate (95.7% in the endoscopic and 100% in the surgical group, P = 0.81). Mean follow‐up period was 37.6 months. Lesions resected endoscopically were significantly larger (68.5 mm) than those resected by transanal resection (44.5 mm), P = 0.003. Curative resections occurred in 97.2% of endoscopic resections and 85.2% of the surgical ones (P = 0.04). Comparing resections that fulfilled histologic curative criteria, there were no recurrences in the endoscopic group (out of 69 cases) and two recurrences in the transanal group (8.3% of 24 cases), P = 0.06. Late complications occurred in 12.7% of endoscopic procedures and 25.9% of surgical procedures (P = 0.13). Conclusions In our experience, endoscopic submucosal resection seems to have advantages over transanal endoscopic microsurgery, with similar en bloc resection rate and lower rate of late complications and recurrences. Multicenter randomized controlled trials are needed to support our findings.

Endoscopic submucosal dissection for ultra‐low large rectal stromal tumor after preoperative imatinib therapy: A case report and review

“…[19][20][21][22][23][24] For large ultra-low rectal GISTs, traditional radical resection may cause severe sphincter injury, urinary Compared with TEM, ESD has similar en bloc and R0 resection rates, shorter hospital stay, and lower rates of late complications and recurrence for resection of early rectal adenocarcinoma and adenoma. 25 However, there have been no studies comparing the efficacy between ESD and other minimally invasive surgeries for the treatment of rectal GISTs as yet. Kim et al reported a case in which a 5.5 cm  4.0 cm rectal GIST was treated effectively by ESD without preoperative imatinib.…”

Impact of a Routine Colorectal Endoscopic Submucosal Dissection in the Surgical Management of Nonmalignant Colorectal Lesions Treated in a Referral Cancer Center

“…[10][11][12][13] It allows a high rate of en bloc resection and a lower recurrence rate than EMR, [14][15][16][17][18] or even transanal endoscopic microsurgery (TEM). 19 Several studies have described the successful outcomes of colorectal ESD and the high accuracy of magnification chromoendoscopy. However, the impact of routinely implementing those procedures on the number of abdominal surgeries for nonmalignant colorectal polyps has not been described.…”

“…10–13 It allows a high rate of en bloc resection and a lower recurrence rate than EMR, 14–18 or even transanal endoscopic microsurgery (TEM). 19…”

Comparison of the efficacy of endoscopic submucosal dissection and transanal endoscopic microsurgery in the treatment of rectal neuroendocrine tumors ≤ 2 cm

“…However, the TEM technique also has higher anaesthesia-related adverse events and postoperative morbidity ( 11 ). Most critically, TEM is not more effective over the long run than ESD ( 14 ). Currently, both ESD and TEM are commonly used techniques for the treatment of rectal NETs ≤2 cm, but there is no consensus on which of the two treatment options is better.…”