Transanal endoscopic microsurgery versus radical resection for early-stage rectal cancer: a systematic review and meta- analysis

Abstract

Purpose In the treatment of early-stage rectal cancer, a growing number of studies have shown that transanal endoscopic microsurgery is one of the alternatives to radical surgery adhering to total mesorectal excision that can reduce the incidence of adverse events without compromising treatment outcomes. The purpose of this meta-analysis is to compare the safety and treatment effect of transanal endoscopic microsurgery and radical surgery adhering to total mesorectal excision to provide a basis for clinical treatment selections. Method We searched the literatures of four major databases, PubMed, Embase, Web of science, and Cochrane Library, without limitation of time. The literatures included randomized controlled studies and cohort studies comparing two surgical procedures of transanal endoscopic microsurgery and radical surgery adhering to total mesorectal excision. Treatment effectiveness and safety results of transanal endoscopic microsurgery and radical surgery were extracted from the included literatures and statistically analyzed using RevMan5.4 and stata17. Result Ultimately, 13 papers were included in the study including 5 randomized controlled studies and 8 cohort studies. The results of the meta-analysis showed that the treatment effect and safety of both transanal endoscopic microsurgery and radical surgery in distant metastasis (RR, 0.59 (0.34, 1.02), P > 0.05), overall recurrence (RR, 1.49 (0.96, 2.31), P > 0.05), disease-specific-survival (RR, 0.74 (0.09, 1.57), P > 0.05), dehiscence of the sutureline or anastomosis leakage (RR, 0.57 (0.30, 1.06), P > 0.05), postoperative bleeding (RR, 0.47 (0.22, 0.99), P > 0.05), and pneumonia (RR, 0.37, (0.10, 1.40), P > 0.05) were not significantly different. However, they differ significantly in perioperative mortality (RR, 0.26 (0.07, 0.93, P < 0.05)), local recurrence (RR, 2.51 (1.53, 4.21), P < 0.05),_overall survival_ (RR, 0.88 (0.74, 1.00), P < 0.05), disease-free-survival (RR, 1.08 (0.97, 1.19), P < 0.05), temporary stoma (RR, 0.05 (0.01, 0.20), P < 0.05), permanent stoma (RR, 0.16 (0.08, 0.33), P < 0.05), postoperative complications (RR, 0.35 (0.21, 0.59), P < 0.05), rectal pain (RR, 1.47 (1.11, 1.95), P < 0.05), operation time (RR, −97.14 (−115.81, −78.47), P < 0.05), blood loss (RR, −315.52 (−472.47, −158.57), P < 0.05), and time of hospitalization (RR, −8.82 (−10.38, −7.26), P < 0.05). Conclusion Transanal endoscopic microsurgery seems to be one of the alternatives to radical surgery for early-stage rectal cancer, but more high-quality clinical studies are needed to provide a reliable basis.

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

“…TEM can be used for endoscopic resection of highly suspicious deep submucosal infiltrating T1 rectal cancer, and has become a feasible alternative to endoscopic treatment such as submucosal resection or intermuscular dissection resection [ 19 ]. In the treatment of early rectal cancer, TEM technology provides an alternative to radical surgery of total mesorectal excision, which can reduce the occurrence of adverse events without affecting the treatment results [ 20 ]. ESD technology uses endoscopic layer-by-layer dissection to remove tumors, which is simpler than TEM, but has a higher risk of intraoperative bleeding and perforation.…”

Current Trends in Advanced Surgical Strategies for the Treatment of Rectal Tumors: A Comprehensive Review of the Most Recent Developments

“…In the context of treating T1 rectal cancer, the choice between different surgical approaches is complex and influenced by several factors. The study by LI et al (2023) andDEKKERS et al, (2022) offer valuable insights into recurrence risk, oncological outcomes, and benefits associated with specific approaches, providing a comprehensive view to guide clinical decisions. LI et al (2023), focusing on the analysis of the risk of recurrence after local and endoscopic surgical resection, highlights an approximate risk of 9%.…”

“…The study by LI et al (2023) andDEKKERS et al, (2022) offer valuable insights into recurrence risk, oncological outcomes, and benefits associated with specific approaches, providing a comprehensive view to guide clinical decisions. LI et al (2023), focusing on the analysis of the risk of recurrence after local and endoscopic surgical resection, highlights an approximate risk of 9%. It emphasizes the importance of the resection technique, preferring TEM/TAMIS, and discusses the influence of histological status on recurrence, especially in low-risk tumors.…”

What Is the Comparative Efficacy of Surgical, Endoscopic, Transanal Resection, and Radiotherapy Modalities in the Treatment of Rectal Cancer?

“…Most effective for early-stage rectal cancer, particularly Tis and T1 N0 M0 tumors [45,46]. Used for higher-stage cancers after neoadjuvant therapy has been explored [47].…”