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Endoscopic submucosal dissection versus transanal endoscopic microsurgery for the treatment of early rectal cancer

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Abstract

Background

Endoscopic submucosal dissection (ESD) and transanal endoscopic microsurgery (TEM) are minimally invasive procedures that can be used to treat early rectal cancer.

Objective

The aim of this study was to compare clinical efficacy between ESD and TEM for the treatment of early rectal cancer.

Methods

Between July 2008 and August 2011, 24 patients with early rectal cancers were treated by ESD (11) or TEM (13) at the Cancer Institute of São Paulo University Medical School (São Paulo, Brazil). Data were analyzed retrospectively according to database and pathological reports, with respect to en bloc resection rate, local recurrence, complications, histological diagnosis, procedure time and length of hospital stay.

Results

En bloc resection rates with free margins were achieved in 81.8 % of patients in the ESD group and 84.6 % of patients in the TEM group (p = 0.40). Mean tumor size was 64.6 ± 57.9 mm in the ESD group and 43.9 ± 30.7 mm in the TEM group (p = 0.13). Two patients in the TEM group and one patient in the ESD group had a local recurrence. The mean procedure time was 133 ± 94.8 min in the ESD group and 150 ± 66.3 min in the TEM group (p = 0.69). Mean hospital stay was 3.8 ± 3.3 days in the ESD group and 4.08 ± 1.7 days in the TEM group (p = 0.81).

Limitations

This was a non-randomized clinical trial with a small sample size and selection bias in treatment options.

Conclusion

ESD and TEM are both safe and effective for the treatment of early rectal cancer.

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Disclosures

Fabio S. Kawaguti, Caio S.R. Nahas, Carlos F.S. Marques, Bruno da Costa Martins, Felipe A. Retes, Raphael S.S. Medeiros, Takemasa Hayashi, Yoshiki Wada, Marcelos S. de Lima, Ricardo S. Uemura, Sergio C. Nahas, Shin-ei Kudo and Fauze Maluf-Filho have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Division of Endoscopy, Cancer Institute of University of São Paulo Medical School, São Paulo, Brazil

    Fábio Shiguehissa Kawaguti, Bruno da Costa Martins, Felipe Alves Retes, Marcelo Simas de Lima, Ricardo Sato Uemura & Fauze Maluf-Filho

  2. Division of Colorectal Surgery, Cancer Institute of University of São Paulo Medical School, São Paulo, Brazil

    Caio Sérgio Rizkallah Nahas, Carlos Frederico Sparapan Marques & Sérgio Carlos Nahas

  3. Division of Pathology, Cancer Institute of University of São Paulo Medical School, São Paulo, Brazil

    Raphael Salles S. Medeiros

  4. Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama City, Kanagawa, Japan

    Takemasa Hayashi, Yoshiki Wada & Shin-ei Kudo

Authors
  1. Fábio Shiguehissa Kawaguti
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  2. Caio Sérgio Rizkallah Nahas
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  3. Carlos Frederico Sparapan Marques
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  5. Felipe Alves Retes
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  6. Raphael Salles S. Medeiros
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  7. Takemasa Hayashi
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  8. Yoshiki Wada
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  9. Marcelo Simas de Lima
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  10. Ricardo Sato Uemura
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  11. Sérgio Carlos Nahas
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  12. Shin-ei Kudo
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  13. Fauze Maluf-Filho
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Corresponding author

Correspondence to Fábio Shiguehissa Kawaguti.

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Kawaguti, F.S., Nahas, C.S.R., Marques, C.F.S. et al. Endoscopic submucosal dissection versus transanal endoscopic microsurgery for the treatment of early rectal cancer. Surg Endosc 28, 1173–1179 (2014). https://doi.org/10.1007/s00464-013-3302-z

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  • DOI: https://doi.org/10.1007/s00464-013-3302-z

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