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Endoscopic submucosal dissection versus transanal endoscopic surgery for the treatment of early rectal tumor: a systematic review and meta-analysis

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Abstract

Background

Minimally invasive treatment of early-stage rectal lesion has presented good results, with lower morbidity than surgical resection. Transanal endoscopic microsurgery (TEM) and transanal minimally invasive surgery (TAMIS) are the main methods of transanal surgery. However, endoscopic submucosal dissection (ESD) has been gaining ground because it allows en bloc resections with low recurrence rates. The aim of this study was to analyze ESD in comparison with transanal endoscopic surgery.

Methods

We searched MEDLINE, EMBASE, SciELO, Cochrane CENTRAL, and Lilacs/Bireme with no restrictions on the date or language of publication. The outcomes evaluated were recurrence rate, complete (R0) resection rate, en bloc resection rate, length of hospital stay, duration of the procedure, and complication rate.

Results

Six retrospective cohort studies involving a collective total of 326 patients—191 in the ESD group and 135 in the transanal endoscopic surgery group were conducted. There were no statistically significant differences between the groups for any of the outcomes evaluated.

Conclusions

For the minimally invasive treatment of early rectal tumor, ESD and surgical techniques do not differ in terms of local recurrence, en bloc resection rate, R0 resection rate, duration of the procedure, length of hospital stay, or complication rate, however, evidence is very low.

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Authors and Affiliations

  1. Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – HC/FMUSP, Av. Dr. Enéas de Carvalho Aguiar, 255 – Instituto Central - Prédio dos Ambulatórios – Cerqueira César, São Paulo, SP, CEP: 05403-000, Brazil

    Vitor Massaro Takamatsu Sagae, Igor Braga Ribeiro, Diogo Turiani Hourneaux de Moura, Vitor Ottoboni Brunaldi, Fernanda Prado Logiudice, Mateus Pereira Funari, Elisa Ryoka Baba, Wanderley Marques Bernardo & Eduardo Guimarães Hourneaux de Moura

  2. Division of Gastroenterology, Hepatology and Endoscopy, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA

    Diogo Turiani Hourneaux de Moura

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Contributions

VS: acquisition of data, analysis, interpretation of data, drafting the article, revising the article, final approval; IBR: acquisition of data, analysis, interpretation of data, drafting the article, revising the article, final approval; IBR: analysis and interpretation of data, revising the article; DTHDM: analysis and interpretation of data, revising the article; VOB: acquisition of data, drafting the article, revising the article, final approval; FPL: analysis and interpretation of data, drafting the article, final approval; MPF: analysis and interpretation of data, drafting the article, final approval; FPL: analysis and interpretation of data, drafting the article, final approval; ERB: analysis and interpretation of data, drafting the article, final approval; WMB: analysis and interpretation of data, drafting the article, final approval; EGHDM: analysis and interpretation of data, drafting the article, revising the article, final approval.

Corresponding author

Correspondence to Igor Braga Ribeiro.

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Drs. Vitor Massaro Takamatsu Sagae, Igor Braga Ribeiro, Diogo Turiani Hourneaux de Moura, Vitor Ottoboni Brunaldi, Fernanda Prado Logiudice, Mateus Pereira Funari, Elisa Ryoka Baba and Wanderley Marques Bernardo, Dr. Eduardo Guimarães Hourneaux de Moura is consultant for Boston scientific and Olympus.

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The study was approved by the Research Ethics Committee of the University of São Paulo School of Medicine Hospital das Clínicas.

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Sagae, V.M.T., Ribeiro, I.B., de Moura, D.T.H. et al. Endoscopic submucosal dissection versus transanal endoscopic surgery for the treatment of early rectal tumor: a systematic review and meta-analysis. Surg Endosc 34, 1025–1034 (2020). https://doi.org/10.1007/s00464-019-07271-2

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