Endoscopic management versus transanal surgery for early primary or early locally recurrent rectal neoplasms-a systematic review and meta-analysis

被引:2
作者
Naughton, Ailish P. [1 ]
Ryan, Eanna J. [1 ]
Bardon, Cliodhna Tutty [1 ]
Boland, Michael R. [1 ]
Aherne, Thomas M. [1 ]
Kelly, Michael E. [1 ]
Whelan, Maria [1 ]
Neary, Paul C. [1 ,2 ]
McNamara, Deirdre [2 ,3 ]
O'Riordan, James M. [1 ,2 ]
Kavanagh, Dara O. [1 ,2 ]
机构
[1] Tallaght Univ Hosp, Dept Surg, Dublin, Ireland
[2] Univ Dublin, Trinity Coll Dublin, Sch Med, Dublin, Ireland
[3] Tallaght Univ Hosp, Dept Gastroenterol, Dublin, Ireland
关键词
Endoscopic mucosal resection; Endoscopic submucosal dissection; Transanal surgery; Local excision; Transanal endoscopic microsurgery; Transanal minimally invasive surgery; Surgical outcomes; MINIMALLY INVASIVE SURGERY; LENGTH-OF-STAY; SUBMUCOSAL DISSECTION; MUCOSAL RESECTION; COLORECTAL-CANCER; EUROPEAN-SOCIETY; MICROSURGERY; COMPLICATIONS; EXCISION; POLYPECTOMY;
D O I
10.1007/s00384-020-03715-7
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background Both endoscopic techniques and transanal surgery are viable options that allow organ preservation for early rectal neoplasms. Whilst endoscopic approaches are less invasive and carry less morbidity, it is unclear whether they are as oncologically effective. Aim To compare endoscopic techniques with transanal surgery in the management of early rectal neoplasms. Methods A systematic literature search was performed for randomised and observational studies comparing these techniques. The pre-specified main outcomes measured were en bloc and R0 resection rates and recurrence. Pair-wise meta-analysis was performed. Results This review included 1044 patients. Transanal surgery had increased R0 resection rates (odds ratio (OR) 2.66; 95% CI 1.64; 4.31;p< 0.001) versus endoscopic management. The latter was associated with higher rates of incomplete resection (OR 2.25; 95% CI 1.14, 4.46;p= 0.02) and further intervention (OR 1.78; 95% CI 1.09, 2.88;p= 0.02). There was no difference in the rates of late recurrence (OR 1.01; 95% CI 0.53, 1.91;p= 0.99) or further major surgery (OR 0.87; 95% CI 0.39, 1.94;p= 0.73) between the groups. Endoscopic treatment was associated with a shorter operating time (weighted mean difference (WMD) - 12.08; 95% CI - 18.97, - 5.19;p< 0.001) and LOS (WMD - 1.94; 95% CI - 2.43, - 1.44;p< 0.001), as well as lower rates of urinary retention post-operatively (OR 0.12; 95% CI 0.02, 0.63;p= 0.01). Conclusion Endoscopic techniques should be favoured in the setting of benign early rectal neoplasms given their decreased morbidity and increased cost-effectiveness. However, where malignancy is suspected transanal surgery should be the preferred option given the superior R0 resection rate.
引用
收藏
页码:2347 / 2359
页数:13
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