Systematic Reviews
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 6, 2024; 12(1): 95-106
Published online Jan 6, 2024. doi: 10.12998/wjcc.v12.i1.95
Endoscopic submucosal dissection vs transanal endoscopic surgery for rectal tumors: A systematic review and meta-analysis
Long-Wu Huang, Ying Zhong
Long-Wu Huang, Ying Zhong, Department of Gastroenterology, Huzhou Third Municipal Hospital, the Affiliated Hospital of Huzhou University, Huzhou 313000, Zhejiang Province, China
Author contributions: Huang LW conceived and designed the study; Huang LW and Zhong Y collected the data and performed the analysis; Zhong Y was involved in the writing of the manuscript and is responsible for the integrity of the study; all authors have read and approved the final manuscript.
Conflict-of-interest statement: All authors declare no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ying Zhong, MD, Doctor, Department of Gastroenterology, Huzhou Third Municipal Hospital, the Affiliated Hospital of Huzhou University, No. 2088 Tiaoxi East Road, Wuxing District, Huzhou 313000, Zhejiang Province, China. chenjinshijin2@163.com
Received: October 13, 2023
Peer-review started: October 13, 2023
First decision: November 28, 2023
Revised: December 12, 2023
Accepted: December 18, 2023
Article in press: December 18, 2023
Published online: January 6, 2024
Processing time: 81 Days and 1.9 Hours
Abstract
BACKGROUND

Endoscopic submucosal dissection (ESD) and transanal endoscopic submucosal dissection (TES) are widely employed surgical techniques. However, the comparative efficacy and safety of both remain inconclusive.

AIM

To comprehensively analyze and discern differences in surgical outcomes between ESD and TES.

METHODS

We conducted a systematic search of the electronic databases PubMed, Embase, Cochrane Central Register of Controlled Trials, Scopus, and CINAHL from inception till August 2023. We analyzed outcomes including recurrence rate, en bloc resection, R0 resection rate, perforation rate, procedure length, and hospital stay length applying a random-effects inverse-variance model. We assessed publication bias by conducting an Egger’s regression test and sensitivity analyses.

RESULTS

We pooled data from 11 studies involving 1013 participants. We found similar recurrence rates, with a pooled odds ratio of 0.545 (95%CI: 0.176-1.687). En bloc resection, R0 resection, and perforation rate values were also similar for both ESD and TES. The pooled analysis for procedure length indicated a mean difference of -4.19 min (95%CI: -22.73 to 14.35), and the hospital stay was on average shorter for ESDs by about 0.789 days (95%CI: -1.671 to 0.093).

CONCLUSION

Both ESD and TES displayed similar efficacy and safety profiles across multiple outcomes. Our findings show that individualized patient and surgeon preferences, alongside specific clinical contexts, can be considered when selecting between these two techniques.

Keywords: Endoscopic submucosal dissection; Transanal endoscopic submucosal dissection; Meta-analysis; Surgical outcomes; Rectal tumours

Core Tip: This meta-analysis compares Endoscopic Submucosal Dissection (ESD) and Transanal Endoscopic Surgery (TES) for rectal tumours, focusing on recurrence rates, resection efficacies, and procedural outcomes. Our findings reveal no significant differences in recurrence or resection rates between ESD and TES, highlighting their comparable efficacies. However, the methods differ in anaesthesia requirements, impacting patient experience and recovery. With substantial heterogeneity in study designs and patient populations, our analysis underscores the need for standardized multicentric studies. This comprehensive comparison provides crucial insights for clinicians in selecting the most appropriate surgical technique based on tumour characteristics, patient profiles, and institutional resources.