Outcomes of Transanal Endoscopic Microsurgery for T1 and T2 rectal cancer
- 45 Downloads
The objective was to evaluate Transanal Endoscopic Microsurgery as a surgical strategy for stage I rectal cancer and its associated perioperative morbidity and oncologic outcomes.
The present meta-analysis pooled the effects of outcomes of 986 patients enrolled in 3 randomized controlled trials, 1 prospective and 6 retrospective comparative studies.
The Meta-analysis revealed an advantage to Transanal Endoscopic Microsurgery over Standard Resection in lessening the number of patients presenting with major (O.R= 0,24 (0,07–0,91) and overall postoperative complications (O.R= 0,16 (0,06–0,38) and prolonging the disease-free survival (O.R= 0,46 (0,24–0,88). On the contrary, Standard Resection was superior in terms of the number of patients with positive margins (O.R= 6,49 (1,49–24,91), local recurrence (O.R= 4,92 (1,81–13,41) and overall (local and distant recurrence: O.R= 2,03 (1,15–3,57). No survival advantage was observed in favour of either procedure. The number of patients with positive margins was less in Transanal Endoscopic Microsurgery when compared to Transanal Excision whilst the reverse applied to the disease-free survival.
In selected cases of early rectal cancer Transanal Endoscopic Microsurgery is superior to Standard Resection concerning morbidity and disease- free survival whilst the reverse applies to positive surgical margins, local and overall recurrence. No survival advantage was observed in favour of either procedure. Taking into consideration the comparison of Transanal Endoscopic Microsurgery versus Transanal Excision, Transanal Endoscopic Microsurgery performs better for negative surgical margins, whereas Transanal Excision shows a greater disease-free survival.
KeywordsTEM Transanal endoscopic microsurgery Total mesorectal excision rectal cancer Transanal excision Low anterior resection
Unable to display preview. Download preview PDF.
- 12.Langer C, Liersch T, Suss M, Siemer A, Markus P, Ghadimi BM, Fuzesi L, Becker H. Surgical cure for early rectal carcinoma and large adenoma: transanal endoscopic microsurgery (using ultrasound or electrosurgery) compared to conventional local and radical resection. Int J Colorectal Dis 2003;18:222–229.PubMedGoogle Scholar
- 16.Lezoche G, Baldarelli M, Guerrieri M, Paganini AM, De Sanctis A, Bartolacci S, Lezoche E. A prospective randomized study with a 5-year minimum follow-up evaluation of transanal endoscopic microsurgery versus laparoscopic total mesorectal excision after neoadjuvant therapy. Surg Endosc 2008;22:352–358.CrossRefPubMedGoogle Scholar
- 18.Dixon MR, Finne CO, Madoff RD, Goldberg J, Mellgren A, Alavi K. Transanal endoscopic microsurgery (TEM) improves outcome in local treatment of early rectal cancer. Dis Colon Rectum 2006;49:715–716.Google Scholar
- 21.Egger. M, Smith. G D, Altman. D G. Systematic Reviews in Health Care: Meta-analysis in Context (2nd edn).. BMJ Books: London 2001.Google Scholar
- 22.Review Manager (RevMan) [Computer program]. Version 5.0. Copenhagen: The Nordic Cochrane Centre TCC, 2008.Google Scholar
- 23.Higgins JPT Green S editors. Cochrane Handbook for Systematic Reviews of Interventions 4.2.6 6 [updated September 2006]. In: The Cochrane Library I, 2006. Chichester, UK: John Wiley & Sons, Ltd.Google Scholar
- 24.Zamora. J, Abraira. V, Muriel. A. Meta-DiSc: a software for meta-analysis of test accuracy data BMC Medical Research Methodology 2006;6:31.Google Scholar
- 25.Rosenberg MS, Adams D. C., Gurevitch J. 2000. MetaWin. Statistical software for meta-analysis. Version 2. Sinauer Asociates, Sunderland, Massachusetts.Google Scholar
- 27.Lezoche E, Guerrieri M, Paganini AM, D’Ambrosio G, Baldarelli M, Lezoche G, Feliciotti F, De Sanctis A. Transanal endoscopic versus total mesorectal laparoscopic resections of T2-N0 low rectal cancers after neoadjuvant treatment: a prospective randomized trial with a 3-years minimum follow-up period. Surg Endosc 2005;19:751–756.CrossRefPubMedGoogle Scholar
- 29.Mahmoud N, Madoff R, Rothenberger D, Finne C. Transanal endoscopic microsurgery (TEM) reduces the incidence of positive margins compared with transanal excision for rectal tumours. Dis Colon Rectum 2001;44.Google Scholar