Endoscopic Submucosal Dissection of Rectal Cancer Close to the Dentate Line Accompanied by Mucosal Prolapse Syndrome

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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Risk Factors for Technical Difficulty of Endoscopic Submucosal Dissection in Colorectal Tumors: A Case Series and Meta-Analysis

10.21203/rs.3.rs-33610/v1 ◽

2020 ◽

Author(s):

Yan Gao ◽

Wei Jiang ◽

Hui-Hong Zhai ◽

Jianing Xu ◽

Shanshan Wu ◽

...

Keyword(s):

Risk Factors ◽

Endoscopic Submucosal Dissection ◽

Meta Analysis ◽

Dentate Line ◽

En Bloc Resection ◽

Bloc Resection ◽

En Bloc ◽

Submucosal Dissection ◽

Submucosal Fibrosis ◽

Lifting Sign

Abstract Background and Aims: Endoscopic submucosal dissection has become widely accepted as an efficient and well-established option for colorectal neoplastic lesions (CRNs). However, there are still some barriers for endoscopists that hinder the successful ESD. The current study was to evaluate risk factors for the failure of en-bloc resection in the colorectal endoscopic submucosal dissection (ESD).Methods: A retrospective chart review was performed from patients who underwent ESD for colorectal neoplasms (CRNs) between January 2015 and April 2017. The demographics and colonoscopic reports were analyzed. A meta-analysis was conducted for the risk factors for the failure of en-bloc or R0 resection. Results: 253 ESD cases were completed in en-bloc resection. Ulcerative colitis, previous abdominal surgeries, lesions on the Bauhin’s valve/ dentate line, non-lifting sign and submucosal fibrosis were associated with the failure of en-bloc resection (P<0.05). Meta-analysis showed that laterally spreading tumors, tumor larger than 40mm, Bauhin’s valve/dentate line, flexure, non-lifting sign, and submucosal fibrosis were the factors for the failure of en bloc or R0 resection. The rates of perforation were obviously higher in N-EBR groups compared to EBR groups. No significant results can be observed on the local recurrence based on these studies. Conclusions: Preoperative factors such as laterally spreading tumors, tumor larger than 40mm, Bauhin’s valve/dentate line, flexure and intraoperative factors such as non-lifting sign, submucosal fibrosis should be put more focus to reach better outcomes in CRNs patients.

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