Su1724 ENDOSCOPIC SUBMUCOSAL DISSECTION VERSUS TRANSANAL ENDOSCOPIC SURGERY FOR EARLY RECTAL CANCER - A SYSTEMATIC REVIEW AND META-ANALISYS OF COMPARATIVE STUDIES

AIM: transanal endomicrosurgery (TEM) is the standard for organ-preserving treatment of patients with large adenomas and early rectal cancer. The advantage of TEM in comparison with other transanal methods of treatment of rectal tumors is the low frequency of R1 resections and fragmentation, which procudes a low level of local recurrences. Endoscopic submucosal dissection (ESD) is a new technology for superficial rectum tumors. This systematic review and meta-analysis compared safety and efficacy of ESD vs TEM for large adenoma and early colorectal cancer.PATIENTS AND METHODS: a literature search and meta-analysis of the data was carried out in accordance with the English-language Medline database without restrictions on the publication date (end December 18, 2018) according to keywords: «endoscopic submucosal dissection», «esd», «endoscopic dissection», «tem», «tamis», «transanal endoscopic microsurgery», «transanal resection», «teo», «transanal endoscopic microsurgical excision». The systematic review includes all papers on the comparison of TEM and ESD for large adenomas and early rectal cancer. Statistical data processing was performed using Review Manager 5.3.RESULTS: four retrospective comparative studies were included in the analysis (215 patients). Groups were homogenous in the number of tumors (Odds ratio [OR]=1,19; 95% confidence interval [CI] 0.23-6.16) and size (p=0.55). The intraoperative morbidity included bleeding (p=0.54) and rectal perforation (p=0.32) was homogenous as well. The operation time in the ESD group was significantly longer by 32 minutes than TEM (OR=32.5;95% CI 17,7-47.4; p<0.0001). Postoperative stay was higher than in 1.6 times after TEM (OR=16.1; 95% CI 1.5-30.1; p=0.03). The antibiotics use after surgery was not significantly different in both groups (p=0.33). The en-bloc resections (p=0.66) and the rate of R1 resections (p=0.74) were not significantly different in both groups. The local recurrence rate was homogenous (p=0.95).CONCLUSIONS: the ESD and TEM procedures are safe and effective techniques for local excision of adenomas and early colorectal cancer, but a randomized study is needed to prove the results.

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

Surgical Endoscopy ◽

10.1007/s00464-019-07271-2 ◽

2019 ◽

Vol 34 (3) ◽

pp. 1025-1034 ◽

Cited By ~ 6

Author(s):

Vitor Massaro Takamatsu Sagae ◽

Igor Braga Ribeiro ◽

Diogo Turiani Hourneaux de Moura ◽

Vitor Ottoboni Brunaldi ◽

Fernanda Prado Logiudice ◽

...

Keyword(s):

Systematic Review ◽

Endoscopic Submucosal Dissection ◽

Endoscopic Surgery ◽

Meta Analysis ◽

Rectal Tumor ◽

Transanal Endoscopic Surgery ◽

Submucosal Dissection

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Endoscopic submucosal dissection versus local excision for early rectal cancer: a systematic review and meta-analysis

Techniques in Coloproctology ◽

10.1007/s10151-015-1383-5 ◽

2015 ◽

Vol 20 (1) ◽

pp. 1-9 ◽

Cited By ~ 4

Author(s):

S. Wang ◽

S. Gao ◽

W. Yang ◽

S. Guo ◽

Y. Li

Keyword(s):

Systematic Review ◽

Rectal Cancer ◽

Endoscopic Submucosal Dissection ◽

Local Excision ◽

Meta Analysis ◽

Early Rectal Cancer ◽

Submucosal Dissection

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Systematic review and meta analysis of published trials comparing the effectiveness of transanal endoscopic microsurgery TEMS and endoscpic submucosal dissection ESD in the management of early rectal cancer T1,T2

International Journal of Surgery ◽

10.1016/j.ijsu.2016.08.158 ◽

2016 ◽

Vol 36 ◽

pp. S62

Author(s):

Y. Rajjoub ◽

N. Saffaf ◽

H. Barr

Keyword(s):

Systematic Review ◽

Rectal Cancer ◽

Transanal Endoscopic Microsurgery ◽

Meta Analysis ◽

Early Rectal Cancer ◽

Submucosal Dissection ◽

Endoscopic Microsurgery

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Subserosal recurrence without mucosal involvement diagnosed 5 years after endoscopic submucosal dissection for early rectal cancer

Endoscopy ◽

10.1055/s-0034-1391495 ◽

2015 ◽

Vol 47 (S 01) ◽

pp. E166-E167

Author(s):

Sung Bae ◽

Woon Jeong ◽

Ok Bae ◽

Seong Baek

Keyword(s):

Rectal Cancer ◽

Endoscopic Submucosal Dissection ◽

Early Rectal Cancer ◽

Submucosal Dissection ◽

Mucosal Involvement

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Early rectal cancer treated by endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR) or transanal endoscopic microsurgery (TEM)

Annals of Laparoscopic and Endoscopic Surgery ◽

10.21037/ales.2018.08.01 ◽

2018 ◽

Vol 3 ◽

pp. 67-67

Author(s):

Mauro Verra ◽

Francesco Riente ◽

Alberto Arezzo

Keyword(s):

Rectal Cancer ◽

Endoscopic Submucosal Dissection ◽

Endoscopic Mucosal Resection ◽

Transanal Endoscopic Microsurgery ◽

Early Rectal Cancer ◽

Mucosal Resection ◽

Submucosal Dissection ◽

Endoscopic Microsurgery

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Su1749 ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) VERSUS TRANSANAL ENDOSCOPIC MICROSURGERY (TEM) FOR THE TREATMENT OF EARLY RECTAL CANCER: COMPARISON OF LONG TERM OUTCOMES

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2019.03.621 ◽

2019 ◽

Vol 89 (6) ◽

pp. AB406 ◽

Cited By ~ 1

Author(s):

Fabio S. Kawaguti ◽

Cintia Mayumi S. Kimura ◽

Carlos F. Marques ◽

Caio Sergio R. Nahas ◽

Vanderlei Segateli ◽

...

Keyword(s):

Rectal Cancer ◽

Endoscopic Submucosal Dissection ◽

Transanal Endoscopic Microsurgery ◽

Early Rectal Cancer ◽

Long Term Outcomes ◽

Submucosal Dissection ◽

Endoscopic Microsurgery

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Can less be more? Organ preservation strategies in the management of rectal cancer

Current Oncology ◽

10.3747/co.26.5841 ◽

2019 ◽

Vol 26 (1) ◽

Cited By ~ 4

Author(s):

F. Rouleau-Fournier ◽

C. J. Brown

Keyword(s):

Rectal Cancer ◽

Local Excision ◽

Endoscopic Surgery ◽

Nonoperative Management ◽

Radical Resection ◽

Current Evidence ◽

Early Rectal Cancer ◽

Current Standard ◽

Transanal Endoscopic Surgery ◽

Histopathologic Features

Background Total mesorectal excision (tme) is the current standard of care for the treatment of rectal cancer. However, that surgery is associated with significant morbidity and mortality. Clinicians and patients are seeking alternatives to radical resection. Currently, prevalent organ-sparing strategies under investigation include local excision and nonoperative management (nom).Methods We reviewed the current evidence in the literature to create an overview of the use of transanal endoscopic surgery and watch-and-wait strategies in the modern management of rectal cancer.Results Compared with radical resection, transanal endoscopic surgery in patients with early rectal cancer (cT1) having favourable histopathologic features is associated with an increased risk of local recurrence, but no difference in 5-year survival. In patients with T2 or early T3 cancer, strategies that use neoadjuvant or adjuvant therapy as adjuncts to local excision are under evaluation. Nonoperative management is a new option for patients who experience a complete clinical response after neoadjuvant chemoradiotherapy (ncrt). The selection criteria that will appropriately identify patients for whom nom will succeed are not established.Conclusions Local excision is appropriate for early rectal cancer with favourable histopathologic features. Although organ-preserving strategies are promising, the quality of the evidence to date is insufficient to replace the current standard care in most patients. Patients should be offered nom in the safe setting of a clinical trial or registry. Rigorous follow-up, including endoscopy and imaging at frequent intervals is recommended when radical resection is forgone.

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