Skip to main content
Erschienen in: Surgical Endoscopy 4/2020

10.07.2019

Endoscopic submucosal dissection (ESD) versus transanal endoscopic microsurgery (TEM) for treatment of rectal tumors: a comparative systematic review and meta-analysis

verfasst von: Thomas R. McCarty, Ahmad Najdat Bazarbashi, Kelly E. Hathorn, Christopher C. Thompson, Hiroyuki Aihara

Erschienen in: Surgical Endoscopy | Ausgabe 4/2020

Einloggen, um Zugang zu erhalten

Abstract

Background

While multiple studies have evaluated endoscopic submucosal dissection (ESD) and transanal endoscopic microsurgery (TEM) to remove large rectal tumors, there remains a paucity of data to evaluate their comparative efficacy and safety. The primary aim of this study was to perform a structured systematic review and meta-analysis to compare efficacy and safety of ESD versus TEM for the treatment of rectal tumors.

Methods

Individualized search strategies were developed from inception through November 2018 in accordance with PRISMA guidelines. Measured outcomes included pooled enbloc resection rates, margin-negative (R0) resection rates, procedure-associated adverse events, and rates of recurrence. This was a cumulative meta-analysis performed by calculating pooled proportions. Heterogeneity was assessed with Cochran Q test and I2 statistics, and publication bias by funnel plot using Egger and Begg tests.

Results

Three studies (n = 158 patients; 55.22% male) were included in this meta-analysis. Patients with ESD compared to TEM had similar age (P = 0.090), rectal tumor size (P = 0.108), and diagnosis rate of adenoma to cancer (P = 0.53). ESD lesions were more proximal as compared to TEM (8.41 ± 3.49 vs. 5.11 ± 1.43 cm from the anal verge; P < 0.001). Procedure time and hospital stay were shorter for ESD compared to TEM [(79.78 ± 24.45 vs. 116.61 ± 19.35 min; P < 0.001) and (3.99 ± 0.32 vs. 5.83 ± 0.94 days; P < 0.001), respectively]. No significant differences between enbloc resection rates [OR 0.98 (95% CI 0.22–4.33); P = 0.98; I2 = 0.00%] and R0 resection rates [OR 1.16 (95% CI 0.36–3.76); P = 0.80; I2 = 0.00%] were noted between ESD and TEM. ESD and TEM reported similar rates of adverse events [OR 1.15 (95% CI 0.47–2.77); P = 0.80; I2 = 0.00%] and rates of recurrence [OR 0.46 (95% CI 0.07–3.14); P = 0.43; I2 = 0.00%].

Conclusion

ESD and TEM possess similar rates of resection, adverse events, and recurrence for patients with large rectal tumors; however, ESD is associated with significantly shorter procedure times and duration of hospitalization. Future studies are needed to evaluate healthcare utilization for these two strategies.
Literatur
1.
Zurück zum Zitat Siegel RL, Miller KD, Jemal A (2019) Cancer statistics, 2019. CA Cancer J Clin 69:7–34 Siegel RL, Miller KD, Jemal A (2019) Cancer statistics, 2019. CA Cancer J Clin 69:7–34
2.
Zurück zum Zitat Park SU, Min YW, Shin JU et al (2012) Endoscopic submucosal dissection or transanal endoscopic microsurgery for nonpolypoid rectal high grade dysplasia and submucosa-invading rectal cancer. Endoscopy 44:1031–1036CrossRef Park SU, Min YW, Shin JU et al (2012) Endoscopic submucosal dissection or transanal endoscopic microsurgery for nonpolypoid rectal high grade dysplasia and submucosa-invading rectal cancer. Endoscopy 44:1031–1036CrossRef
3.
Zurück zum Zitat Park HW, Byeon JS, Park YS et al (2010) Endoscopic submucosal dissection for treatment of rectal carcinoid tumors. Gastrointest Endosc 72:143–149CrossRef Park HW, Byeon JS, Park YS et al (2010) Endoscopic submucosal dissection for treatment of rectal carcinoid tumors. Gastrointest Endosc 72:143–149CrossRef
4.
Zurück zum Zitat Nam MJ, Sohn DK, Hong CW et al (2015) Cost comparison between endoscopic submucosal dissection and transanal endoscopic microsurgery for the treatment of rectal tumors. Ann Surg Treat Res 89:202–207CrossRef Nam MJ, Sohn DK, Hong CW et al (2015) Cost comparison between endoscopic submucosal dissection and transanal endoscopic microsurgery for the treatment of rectal tumors. Ann Surg Treat Res 89:202–207CrossRef
5.
Zurück zum Zitat Repici A, Hassan C, De Paula Pessoa D et al (2012) Efficacy and safety of endoscopic submucosal dissection for colorectal neoplasia: a systematic review. Endoscopy 44:137–150CrossRef Repici A, Hassan C, De Paula Pessoa D et al (2012) Efficacy and safety of endoscopic submucosal dissection for colorectal neoplasia: a systematic review. Endoscopy 44:137–150CrossRef
6.
Zurück zum Zitat Guerrieri M, Baldarelli M, de Sanctis A, Campagnacci R, Rimini M, Lezoche E (2010) Treatment of rectal adenomas by transanal endoscopic microsurgery: 15 years’ experience. Surg Endosc 24:445–449CrossRef Guerrieri M, Baldarelli M, de Sanctis A, Campagnacci R, Rimini M, Lezoche E (2010) Treatment of rectal adenomas by transanal endoscopic microsurgery: 15 years’ experience. Surg Endosc 24:445–449CrossRef
7.
Zurück zum Zitat Kunitake H, Abbas MA (2012) Transanal endoscopic microsurgery for rectal tumors: a review. Perm J 16:45–50CrossRef Kunitake H, Abbas MA (2012) Transanal endoscopic microsurgery for rectal tumors: a review. Perm J 16:45–50CrossRef
8.
Zurück zum Zitat Kawaguti FS, Nahas CS, Marques CF et al (2014) Endoscopic submucosal dissection versus transanal endoscopic microsurgery for the treatment of early rectal cancer. Surg Endosc 28:1173–1179CrossRef Kawaguti FS, Nahas CS, Marques CF et al (2014) Endoscopic submucosal dissection versus transanal endoscopic microsurgery for the treatment of early rectal cancer. Surg Endosc 28:1173–1179CrossRef
9.
Zurück zum Zitat Jung Y, Lee J, Cho JY et al (2018) Comparison of efficacy and safety between endoscopic submucosal dissection and transanal endoscopic microsurgery for the treatment of rectal tumor. Saudi J Gastroenterol 24:115–121CrossRef Jung Y, Lee J, Cho JY et al (2018) Comparison of efficacy and safety between endoscopic submucosal dissection and transanal endoscopic microsurgery for the treatment of rectal tumor. Saudi J Gastroenterol 24:115–121CrossRef
10.
Zurück zum Zitat Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med 151:W65–W94CrossRef Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med 151:W65–W94CrossRef
11.
Zurück zum Zitat Sterne JA, Hernan MA, Reeves BC et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919CrossRef Sterne JA, Hernan MA, Reeves BC et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919CrossRef
13.
Zurück zum Zitat Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560CrossRef Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560CrossRef
14.
Zurück zum Zitat Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634CrossRef Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634CrossRef
15.
Zurück zum Zitat DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188CrossRef DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188CrossRef
16.
Zurück zum Zitat Stuart A, Ord JK (1994) Kendall’s advanced theory of statistics, 6th edn. Edward Arnold, London Stuart A, Ord JK (1994) Kendall’s advanced theory of statistics, 6th edn. Edward Arnold, London
17.
Zurück zum Zitat Suzuki H, Furukawa K, Kan H et al (2005) The role of transanal endoscopic microsurgery for rectal tumors. J Nippon Med Sch 72:278–284CrossRef Suzuki H, Furukawa K, Kan H et al (2005) The role of transanal endoscopic microsurgery for rectal tumors. J Nippon Med Sch 72:278–284CrossRef
18.
Zurück zum Zitat Tanaka S, Toyonaga T, Morita Y et al (2016) Feasibility and safety of endoscopic submucosal dissection for lower rectal tumors with hemorrhoids. World J Gastroenterol 22:6268–6275CrossRef Tanaka S, Toyonaga T, Morita Y et al (2016) Feasibility and safety of endoscopic submucosal dissection for lower rectal tumors with hemorrhoids. World J Gastroenterol 22:6268–6275CrossRef
19.
Zurück zum Zitat Arezzo A, Passera R, Saito Y et al (2014) Systematic review and meta-analysis of endoscopic submucosal dissection versus transanal endoscopic microsurgery for large noninvasive rectal lesions. Surg Endosc 28:427–438CrossRef Arezzo A, Passera R, Saito Y et al (2014) Systematic review and meta-analysis of endoscopic submucosal dissection versus transanal endoscopic microsurgery for large noninvasive rectal lesions. Surg Endosc 28:427–438CrossRef
20.
Zurück zum Zitat Saito Y, Sakamoto T, Nakajima T, Matsuda T (2014) Colorectal ESD: current indications and latest technical advances. Gastrointest Endosc Clin N Am 24:245–255CrossRef Saito Y, Sakamoto T, Nakajima T, Matsuda T (2014) Colorectal ESD: current indications and latest technical advances. Gastrointest Endosc Clin N Am 24:245–255CrossRef
21.
Zurück zum Zitat Takeuchi Y, Uedo N, Ishihara R et al (2010) Efficacy of an endo-knife with a water-jet function (Flushknife) for endoscopic submucosal dissection of superficial colorectal neoplasms. Am J Gastroenterol 105:314–322CrossRef Takeuchi Y, Uedo N, Ishihara R et al (2010) Efficacy of an endo-knife with a water-jet function (Flushknife) for endoscopic submucosal dissection of superficial colorectal neoplasms. Am J Gastroenterol 105:314–322CrossRef
22.
Zurück zum Zitat Toyoizumi H, Kaise M, Arakawa H et al (2009) Ultrathin endoscopy versus high-resolution endoscopy for diagnosing superficial gastric neoplasia. Gastrointest Endosc 70:240–245CrossRef Toyoizumi H, Kaise M, Arakawa H et al (2009) Ultrathin endoscopy versus high-resolution endoscopy for diagnosing superficial gastric neoplasia. Gastrointest Endosc 70:240–245CrossRef
23.
Zurück zum Zitat Maslekar S, Pillinger SH, Sharma A, Taylor A, Monson JR (2007) Cost analysis of transanal endoscopic microsurgery for rectal tumours. Colorectal Dis 9:229–234CrossRef Maslekar S, Pillinger SH, Sharma A, Taylor A, Monson JR (2007) Cost analysis of transanal endoscopic microsurgery for rectal tumours. Colorectal Dis 9:229–234CrossRef
25.
Zurück zum Zitat Hon SS, Ng SS, Chiu PW et al (2011) Endoscopic submucosal dissection versus local excision for early rectal neoplasms: a comparative study. Surg Endosc 25:3923–3927CrossRef Hon SS, Ng SS, Chiu PW et al (2011) Endoscopic submucosal dissection versus local excision for early rectal neoplasms: a comparative study. Surg Endosc 25:3923–3927CrossRef
26.
Zurück zum Zitat Hitzler MH, Heintz A (2015) Single centre study: results of transanal endoscopic microsurgery of rectal tumors since 2003 vs. results of endoscopic submucosal dissection reported in the literature. Zentralbl Chir 140:645–650CrossRef Hitzler MH, Heintz A (2015) Single centre study: results of transanal endoscopic microsurgery of rectal tumors since 2003 vs. results of endoscopic submucosal dissection reported in the literature. Zentralbl Chir 140:645–650CrossRef
Metadaten
Titel
Endoscopic submucosal dissection (ESD) versus transanal endoscopic microsurgery (TEM) for treatment of rectal tumors: a comparative systematic review and meta-analysis
verfasst von
Thomas R. McCarty
Ahmad Najdat Bazarbashi
Kelly E. Hathorn
Christopher C. Thompson
Hiroyuki Aihara
Publikationsdatum
10.07.2019
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 4/2020
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-019-06945-1

Weitere Artikel der Ausgabe 4/2020

Surgical Endoscopy 4/2020 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.