Comparison of transanal endomicrosurgery and total mesorectumectomy in treatment of early rectal cancer (a systematic literature review and meta-analysis)

Abstract

Transanal endomicrosurgery (TEM) presently is the only method for local excision of early rectal cancer with sufficient visualization, possibility for full-wall excision to achieve adequately deep margin of resection for disease staging. Despite the obvious advantage in immediate outcomes of transanal endomicrosurgery over mesorectumectomy, nowadays only in a small number of studies the oncological outcomes were compared. In this regard were performed a systematic review of literature and meta-analysis.AIM OF THE STUDY: to compare the immediate (frequency of complications, duration of operation and intraoperative blood loss) and long-term (frequency of distant metastases and local recurrences) results of TEM and mesorectumectomy in early rectal cancer.MATERIALS AND METHODS: literature search was performed according to PRISMA guidelines. Statistical processing of data was performed with use of Review Manager 5.3. Program.RESULTS: in 4 studies (1 randomized, 2 retrospective, 1 prospective), that were included in meta-analysis the results of treatment of 422 patients were described (240-TEM, 182-mesorectumectomy). The odds-ratio of incidence of postoperative complications after mesorectumectomy was higher for almost 5 times than after TEM (OR 0,21; 95% CI: 0,06 0,74; p = 0,02), as well as the frequency of reoperations in case for complications (OR 0,16; 95% CI: 0,06 0,59; p = 0,02). As well as the overall recurrence rate in TEM group (OR 2,37; 95% CI:1,04 5,39 p = 0,04), the rate of local recurrence (OR 4,61; 95% CI: 1,08 19,6; p = 0,04) was statistically higher than in total mesorectumectomy. At the same time there were no statistically significant difference in incidence of distant metastases (OR 01,0; 95% CI: 0,35 2,84; p = 1,0).CONCLUSION: transanal endomicrosurgery is the method of choice and is safer than mesorectumectomy. However, oncological outcomes depend on many factors which presence must be taken into account when planning for surgical treatment of early rectal cancer.