Published online Jan 6, 2024. doi: 10.12998/wjcc.v12.i1.95
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
Rectal tumors, whether benign or malignant, pose considerable management challenges due to their anatomical location and the complications and morbidity associated with their surgical resection. Traditional surgical techniques, while effective, often require extensive tissue dissection, resulting in prolonged recovery, potential for morbidity, and significant bowel function alterations.
This study addresses the comparative efficacy and safety of two widely employed surgical techniques for rectal tumours - endoscopic submucosal dissection (ESD) and transanal endoscopic surgery (TES), which are yet to be conclusively compared.
The primary objective was to analyze and discern the differences in surgical outcomes between ESD and TES. By reviewing various studies, the research aims to provide a clearer understanding of these techniques' efficacies and potential roles in modern surgical practice.
A systematic review and meta-analysis were conducted following the PRISMA 2020 guidelines. The study included randomized controlled trials, observational studies, and cohort studies that compared outcomes such as local recurrence, en bloc resection rate, R0 resection rate, procedure length, hospital stay length, and complication rates in patients with rectal tumours undergoing ESD or TES.
The meta-analysis of 11 studies found no significant differences between ESD and TES in terms of recurrence rates, en bloc and R0 resection rates, and perforation rates. The study noted similar procedure lengths and a non-significant trend towards shorter hospital stays for ESD. Substantial heterogeneity was observed in some outcomes, indicating variations in study designs, patient populations, and surgical techniques.
The study concludes that both ESD and TES have similar efficacy and safety profiles for treating rectal tumours. The choice between these techniques can be based on individual patient needs, tumour characteristics, surgeon expertise, and available resources. However, the presence of heterogeneity in study results and the lack of randomized controlled trials suggest that future standardized studies are needed.
Future research should focus on standardizing methodologies and reporting outcomes to minimize heterogeneity observed in current studies. Additionally, a deeper exploration of patient-specific variables and an emphasis on surgeon expertise and institutional capabilities will be crucial in refining the choice between ESD and TES for individual patients.