内镜下粘膜剥离术与经肛门内镜手术治疗直肠肿瘤的比较：系统回顾和荟萃分析

IF 2.2 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Clinics Pub Date : 2025-01-01 DOI:10.1016/j.clinsp.2025.100613

Igor Valdeir Gomes de Sousa, Alexandre Moraes Bestetti, Diego Paul Cadena-Aguirre, Angelo So Taa Kum, Paulo Ferreira Mega, Pedro Henrique Veras Ayres da Silva, Nelson Tomio Miyajima, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura

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引用次数: 0

摘要

背景和目的微创技术为早期结直肠癌的治疗提供了传统手术的替代方案，降低了发病率。经肛门内镜显微手术（TEM）和经肛门微创手术（TAMIS）被广泛应用，而内镜下粘膜夹层（ESD）因其完全切除和低复发率而受到关注。本研究比较了ESD与经肛门内镜手术（TES）的疗效和安全性。方法：作者对涉及内镜下可切除直肠病变患者的比较研究进行了系统回顾和荟萃分析。在MEDLINE、EMBASE、Cochrane和LILACS中进行电子检索。结果包括复发率、完全切除、整体切除、住院时间、手术时间和并发症发生率。结果纳入10项观察性研究和1项随机对照试验（RCT），共纳入1094例患者。两种方法在复发率、整体切除、R0切除和并发症方面均无显著差异。RCT显示TES手术时间较短(RD = 16.6；95% CI 8.88 ~ 24.32；p & lt;0.0001)，而观察性研究没有发现显著差异。此外，观察性研究发现，ESD患者的住院时间较短(MD = -1.22；95% CI -2.11 ~ -0.33；I2 = 82%；p & lt;0.007)，而RCT没有发现差异。结论esd和TES治疗早期直肠肿瘤安全有效。局部复发率、阻断切除术、R0切除术、并发症和手术时间相似。然而，RCT显示TES的手术时间较短，而观察性研究显示ESD的住院时间较短。

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Comparison of endoscopic submucosal dissection and transanal endoscopic surgery for the treatment of rectal neoplasia: A systematic review and meta-analysis

Background and aim

Minimally invasive techniques offer alternatives to conventional surgery in the treatment of early-stage colorectal cancer, reducing morbidity. Transanal Endoscopic Microsurgery (TEM) and Transanal Minimally Invasive Surgery (TAMIS) are widely used, while Endoscopic Submucosal Dissection (ESD) is gaining attention for its ability to achieve complete resection with low recurrence rates. This study compares the efficacy and safety of ESD with Transanal Endoscopic Surgery (TES).

Methods

The authors performed a systematic review and meta-analysis of comparative studies involving patients with endoscopically resectable rectal lesions. Electronic searches were conducted in MEDLINE, EMBASE, Cochrane, and LILACS. Outcomes included recurrence rate, complete resection, en bloc resection, hospital stay, procedure time, and complication rate.

Results

The analysis included ten observational studies and one Randomized Controlled Trial (RCT) involving 1,094 patients. No significant differences were found in terms of recurrence rate, en bloc resection, R0 resection, and complications between techniques. The RCT showed a shorter procedure time in the TES (RD = 16.6; 95 % CI 8.88 to 24.32; p < 0.0001), whereas observational studies found no significant difference. In addition, observational studies found a shorter hospital stay duration in the ESD (MD = -1.22; 95 % CI -2.11 to -0.33; I² = 82 %; p < 0.007), while the RCT found no difference.

Conclusion

ESD and TES are safe and effective for the treatment of early-stage rectal tumors. Rates of local recurrence, block resection, R0 resection, complications, and procedure time were similar. However, the RCT showed a shorter procedure time with TES, while observational studies showed a shorter hospital stay with ESD.

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来源期刊

Clinics 医学-医学：内科

CiteScore

4.10

自引率

3.70%

发文量

129

审稿时长

52 days

期刊介绍： CLINICS is an electronic journal that publishes peer-reviewed articles in continuous flow, of interest to clinicians and researchers in the medical sciences. CLINICS complies with the policies of funding agencies which request or require deposition of the published articles that they fund into publicly available databases. CLINICS supports the position of the International Committee of Medical Journal Editors (ICMJE) on trial registration.