内镜下粘膜夹层与经肛门内镜显微手术治疗早期直肠神经内分泌肿瘤的meta分析。

IF 2.1 4区 医学 Q2 SURGERY
Journal of Investigative Surgery Pub Date : 2023-12-01 Epub Date: 2023-11-16 DOI:10.1080/08941939.2023.2278191
Fu-Gang Wang, Ying Jiang, Chao Liu, Hong Qi
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引用次数: 0

摘要

目的:比较内镜下粘膜剥离术(ESD)与经肛门内镜显微手术(TEM)治疗早期直肠神经内分泌肿瘤(RNET)的有效性、安全性和成本效益。本文将为外科医生的临床决策提供可靠的依据。方法:系统检索2013年4月30日至2023年4月30日Pubmed、Embase和Cochrane数据库的文献。采用Newcastle-Ottawa量表(NOS)进行方法学验证。使用Review manager 5.3版软件进行数据分析。结果:我们的荟萃分析共纳入了三项回顾性研究。所有符合条件的研究都被认为是高质量的。通过比较TEM组和ESD组的基线特征,TEM组患者似乎具有肿瘤体积更大、肿瘤水平更低的特征,尽管没有发现统计学意义。TEM在R0切除率、手术时间和住院时间方面具有明显的统计学意义。两组患者的复发率、不良事件发生率及额外治疗率均无统计学意义。结论:与ESD相比,TEM是早期RNET患者更有效的治疗方式;它与相对较高的R0切除率和类似程度的安全性相关。但相对较高的成本和复杂的操作限制了瞬变电磁法的推广。如果经济条件和医院设施允许,外科医生应选择TEM作为肿瘤大小较大和肿瘤浸润程度较深的患者的主要治疗方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparison between Endoscopic Submucosal Dissection and Transanal Endoscopic Microsurgery in Early Rectal Neuroendocrine Tumor Patients: A Meta-Analysis.

Purpose: To compare the effectiveness, safety and cost-effectiveness of endoscopic submucosal dissection (ESD) with transanal endoscopic microsurgery (TEM) in early rectal neuroendocrine tumor (RNET) patients. This article will provide reliable evidence for surgeons in regards to clinical decision-making.

Methods: Systematic literature retrieval was performed in Pubmed, Embase and Cochrane database from 2013/4/30 to 2023/4/30. Methodology validation was performed by using the Newcastle-Ottawa Scale (NOS). Data-analysis was conducted by using the Review manager version 5.3 software.

Results: A total of three retrospective studies were included in our meta-analysis. All eligible studies were considered to be high quality. By comparing baseline characteristics between TEM and ESD, patients in the TEM group seemed to be characterized by a larger tumor size and lower tumor level, even though no statistical significance was found. Clear statistical significance favoring TEM was identified in terms of R0 resection rate, procedure time and hospital stay. No statistical significance was found in terms of recurrence rate, adverse events rate and additional treatment rate.

Conclusions: Compared with ESD, TEM was a more effective treatment modality for early RNET patients; it was associated with a relatively higher R0 resection rate and a similar degree of safety. However, the relatively higher cost and complicated manipulation restricted the promotion of TEM. Surgeons should opt for TEM as a primary treatment in patients with a larger tumor size and deeper degree of tumorous infiltration if the financial condition and hospital facility permit.

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来源期刊
CiteScore
4.20
自引率
0.00%
发文量
114
审稿时长
6-12 weeks
期刊介绍: Journal of Investigative Surgery publishes peer-reviewed scientific articles for the advancement of surgery, to the ultimate benefit of patient care and rehabilitation. It is the only journal that encompasses the individual and collaborative efforts of scientists in human and veterinary medicine, dentistry, basic and applied sciences, engineering, and law and ethics. The journal is dedicated to the publication of outstanding articles of interest to the surgical research community.
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