Is Endoscopic Submucosal Dissection Truly Comparable to Transanal Endoscopic Microsurgery for Early Rectal Epithelial and Subepithelial Tumors? A Meta-Analysis.

IF 1.1 4区 医学 Q3 SURGERY
Hind El Naamani, Joseph A Sujka, Raja Hamsa Chitturi, Damanpartap Singh Sandhu, Madhu Babu Adusmilli, Salvatore Docimo, Christopher G DuCoin, Abdul-Rahman F Diab
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引用次数: 0

Abstract

Background: Early rectal tumors can be effectively managed using transanal endoscopic microsurgery (TEM) and endoscopic submucosal dissection (ESD). This study aimed to compare ESD and TEM in the resection of early rectal tumors concerning en bloc resection rates, R0 resection rates, mean procedural times, perforation rates, bleeding rates, adverse events/complication rates, and mean length of stay (LOS). Methods: We conducted a systematic literature review in accordance with PRISMA guidelines to identify studies directly comparing ESD and TEM for the resection of early rectal tumors. A pairwise meta-analysis was performed using a random-effects model, reporting odds ratios and mean differences. Results: The R0 resection rate was lower in the ESD group. Subgroup analysis indicated that the reduced R0 resection rate in ESD remained significant in the subepithelial subgroup but not in the epithelial subgroup, with the subgroup difference reaching statistical significance (P = .05) but didn't meet conventional statistical significance (P < .05). The number needed to treat with ESD to result in one additional missed R0 resection (harmful event) compared to TEM was 10 (95% CI 4-162). The ESD group demonstrated significantly shorter mean procedural times and LOS, with no significant subgroup differences between epithelial and subepithelial tumors. Conclusions: This study suggests that ESD is associated with a lower R0 resection rate compared to TEM, but offers a shorter mean LOS and procedural time. To date, no randomized controlled trials (RCTs) have been published. Large-scale RCTs that also involve operators who have achieved technical mastery in ESD and TEM are necessary to reach more definitive conclusions. Until such RCTs are published, strong recommendations cannot be made. Additionally, further studies are required to assess whether tumor origin (epithelial versus subepithelial) impacts the R0 resection rate in ESD.

内镜下粘膜夹层真的能与经肛门内镜显微手术治疗早期直肠上皮和上皮下肿瘤相比吗?一个荟萃分析。
背景:经肛门内镜下显微手术(TEM)和内镜下粘膜剥离术(ESD)可以有效地治疗早期直肠肿瘤。本研究旨在比较ESD和TEM在直肠早期肿瘤切除术中的整体切除率、R0切除率、平均手术时间、穿孔率、出血率、不良事件/并发症发生率和平均住院时间(LOS)。方法:我们根据PRISMA指南进行了系统的文献综述,找出直接比较ESD和TEM切除早期直肠肿瘤的研究。采用随机效应模型进行两两荟萃分析,报告优势比和平均差异。结果:ESD组R0切除率较低。亚组分析显示,ESD的R0切除率降低在上皮下亚组有显著性,而在上皮亚组无显著性,亚组间差异有统计学意义(P = 0.05),但不符合常规统计学意义(P < 0.05)。与TEM相比,使用ESD治疗导致1例额外的R0切除(有害事件)的数量为10例(95% CI 4-162)。ESD组表现出更短的平均手术时间和LOS,上皮和上皮下肿瘤之间没有显著的亚组差异。结论:本研究表明,与TEM相比,ESD与较低的R0切除率相关,但提供更短的平均LOS和手术时间。迄今为止,尚未发表随机对照试验(rct)。为了得出更明确的结论,有必要进行大规模的随机对照试验,让掌握ESD和TEM技术的操作人员参与其中。在这些随机对照试验发表之前,无法提出强有力的建议。此外,还需要进一步的研究来评估肿瘤起源(上皮与上皮下)是否会影响ESD的R0切除率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.90
自引率
0.00%
发文量
163
审稿时长
3 months
期刊介绍: Journal of Laparoendoscopic & Advanced Surgical Techniques (JLAST) is the leading international peer-reviewed journal for practicing surgeons who want to keep up with the latest thinking and advanced surgical technologies in laparoscopy, endoscopy, NOTES, and robotics. The Journal is ideally suited to surgeons who are early adopters of new technology and techniques. Recognizing that many new technologies and techniques have significant overlap with several surgical specialties, JLAST is the first journal to focus on these topics both in general and pediatric surgery, and includes other surgical subspecialties such as: urology, gynecologic surgery, thoracic surgery, and more.
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