Cargando…

Transanal endoscopic microsurgery versus radical resection for early-stage rectal cancer: a systematic review and meta- analysis

PURPOSE: In the treatment of early-stage rectal cancer, a growing number of studies have shown that transanal endoscopic microsurgery is one of the alternatives to radical surgery adhering to total mesorectal excision that can reduce the incidence of adverse events without compromising treatment out...

Descripción completa

Detalles Bibliográficos
Autores principales: Li, Wei, Xiang, Xing Xing, Da Wang, Hong, Cai, Chen Jun, Cao, Ying Hao, Liu, Tao
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9938057/
https://www.ncbi.nlm.nih.gov/pubmed/36800079
http://dx.doi.org/10.1007/s00384-023-04341-9
_version_ 1784890557922803712
author Li, Wei
Xiang, Xing Xing
Da Wang, Hong
Cai, Chen Jun
Cao, Ying Hao
Liu, Tao
author_facet Li, Wei
Xiang, Xing Xing
Da Wang, Hong
Cai, Chen Jun
Cao, Ying Hao
Liu, Tao
author_sort Li, Wei
collection PubMed
description PURPOSE: In the treatment of early-stage rectal cancer, a growing number of studies have shown that transanal endoscopic microsurgery is one of the alternatives to radical surgery adhering to total mesorectal excision that can reduce the incidence of adverse events without compromising treatment outcomes. The purpose of this meta-analysis is to compare the safety and treatment effect of transanal endoscopic microsurgery and radical surgery adhering to total mesorectal excision to provide a basis for clinical treatment selections. METHOD: We searched the literatures of four major databases, PubMed, Embase, Web of science, and Cochrane Library, without limitation of time. The literatures included randomized controlled studies and cohort studies comparing two surgical procedures of transanal endoscopic microsurgery and radical surgery adhering to total mesorectal excision. Treatment effectiveness and safety results of transanal endoscopic microsurgery and radical surgery were extracted from the included literatures and statistically analyzed using RevMan5.4 and stata17. RESULT: Ultimately, 13 papers were included in the study including 5 randomized controlled studies and 8 cohort studies. The results of the meta-analysis showed that the treatment effect and safety of both transanal endoscopic microsurgery and radical surgery in distant metastasis (RR, 0.59 (0.34, 1.02), P > 0.05), overall recurrence (RR, 1.49 (0.96, 2.31), P > 0.05), disease-specific-survival (RR, 0.74 (0.09, 1.57), P > 0.05), dehiscence of the sutureline or anastomosis leakage (RR, 0.57 (0.30, 1.06), P > 0.05), postoperative bleeding (RR, 0.47 (0.22, 0.99), P > 0.05), and pneumonia (RR, 0.37, (0.10, 1.40), P > 0.05) were not significantly different. However, they differ significantly in perioperative mortality (RR, 0.26 (0.07, 0.93, P < 0.05)), local recurrence (RR, 2.51 (1.53, 4.21), P < 0.05),_overall survival_ (RR, 0.88 (0.74, 1.00), P < 0.05), disease-free-survival (RR, 1.08 (0.97, 1.19), P < 0.05), temporary stoma (RR, 0.05 (0.01, 0.20), P < 0.05), permanent stoma (RR, 0.16 (0.08, 0.33), P < 0.05), postoperative complications (RR, 0.35 (0.21, 0.59), P < 0.05), rectal pain (RR, 1.47 (1.11, 1.95), P < 0.05), operation time (RR, −97.14 (−115.81, −78.47), P < 0.05), blood loss (RR, −315.52 (−472.47, −158.57), P < 0.05), and time of hospitalization (RR, −8.82 (−10.38, −7.26), P < 0.05). CONCLUSION: Transanal endoscopic microsurgery seems to be one of the alternatives to radical surgery for early-stage rectal cancer, but more high-quality clinical studies are needed to provide a reliable basis.
format Online
Article
Text
id pubmed-9938057
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Springer Berlin Heidelberg
record_format MEDLINE/PubMed
spelling pubmed-99380572023-02-19 Transanal endoscopic microsurgery versus radical resection for early-stage rectal cancer: a systematic review and meta- analysis Li, Wei Xiang, Xing Xing Da Wang, Hong Cai, Chen Jun Cao, Ying Hao Liu, Tao Int J Colorectal Dis Review PURPOSE: In the treatment of early-stage rectal cancer, a growing number of studies have shown that transanal endoscopic microsurgery is one of the alternatives to radical surgery adhering to total mesorectal excision that can reduce the incidence of adverse events without compromising treatment outcomes. The purpose of this meta-analysis is to compare the safety and treatment effect of transanal endoscopic microsurgery and radical surgery adhering to total mesorectal excision to provide a basis for clinical treatment selections. METHOD: We searched the literatures of four major databases, PubMed, Embase, Web of science, and Cochrane Library, without limitation of time. The literatures included randomized controlled studies and cohort studies comparing two surgical procedures of transanal endoscopic microsurgery and radical surgery adhering to total mesorectal excision. Treatment effectiveness and safety results of transanal endoscopic microsurgery and radical surgery were extracted from the included literatures and statistically analyzed using RevMan5.4 and stata17. RESULT: Ultimately, 13 papers were included in the study including 5 randomized controlled studies and 8 cohort studies. The results of the meta-analysis showed that the treatment effect and safety of both transanal endoscopic microsurgery and radical surgery in distant metastasis (RR, 0.59 (0.34, 1.02), P > 0.05), overall recurrence (RR, 1.49 (0.96, 2.31), P > 0.05), disease-specific-survival (RR, 0.74 (0.09, 1.57), P > 0.05), dehiscence of the sutureline or anastomosis leakage (RR, 0.57 (0.30, 1.06), P > 0.05), postoperative bleeding (RR, 0.47 (0.22, 0.99), P > 0.05), and pneumonia (RR, 0.37, (0.10, 1.40), P > 0.05) were not significantly different. However, they differ significantly in perioperative mortality (RR, 0.26 (0.07, 0.93, P < 0.05)), local recurrence (RR, 2.51 (1.53, 4.21), P < 0.05),_overall survival_ (RR, 0.88 (0.74, 1.00), P < 0.05), disease-free-survival (RR, 1.08 (0.97, 1.19), P < 0.05), temporary stoma (RR, 0.05 (0.01, 0.20), P < 0.05), permanent stoma (RR, 0.16 (0.08, 0.33), P < 0.05), postoperative complications (RR, 0.35 (0.21, 0.59), P < 0.05), rectal pain (RR, 1.47 (1.11, 1.95), P < 0.05), operation time (RR, −97.14 (−115.81, −78.47), P < 0.05), blood loss (RR, −315.52 (−472.47, −158.57), P < 0.05), and time of hospitalization (RR, −8.82 (−10.38, −7.26), P < 0.05). CONCLUSION: Transanal endoscopic microsurgery seems to be one of the alternatives to radical surgery for early-stage rectal cancer, but more high-quality clinical studies are needed to provide a reliable basis. Springer Berlin Heidelberg 2023-02-17 2023 /pmc/articles/PMC9938057/ /pubmed/36800079 http://dx.doi.org/10.1007/s00384-023-04341-9 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Review
Li, Wei
Xiang, Xing Xing
Da Wang, Hong
Cai, Chen Jun
Cao, Ying Hao
Liu, Tao
Transanal endoscopic microsurgery versus radical resection for early-stage rectal cancer: a systematic review and meta- analysis
title Transanal endoscopic microsurgery versus radical resection for early-stage rectal cancer: a systematic review and meta- analysis
title_full Transanal endoscopic microsurgery versus radical resection for early-stage rectal cancer: a systematic review and meta- analysis
title_fullStr Transanal endoscopic microsurgery versus radical resection for early-stage rectal cancer: a systematic review and meta- analysis
title_full_unstemmed Transanal endoscopic microsurgery versus radical resection for early-stage rectal cancer: a systematic review and meta- analysis
title_short Transanal endoscopic microsurgery versus radical resection for early-stage rectal cancer: a systematic review and meta- analysis
title_sort transanal endoscopic microsurgery versus radical resection for early-stage rectal cancer: a systematic review and meta- analysis
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9938057/
https://www.ncbi.nlm.nih.gov/pubmed/36800079
http://dx.doi.org/10.1007/s00384-023-04341-9
work_keys_str_mv AT liwei transanalendoscopicmicrosurgeryversusradicalresectionforearlystagerectalcancerasystematicreviewandmetaanalysis
AT xiangxingxing transanalendoscopicmicrosurgeryversusradicalresectionforearlystagerectalcancerasystematicreviewandmetaanalysis
AT dawanghong transanalendoscopicmicrosurgeryversusradicalresectionforearlystagerectalcancerasystematicreviewandmetaanalysis
AT caichenjun transanalendoscopicmicrosurgeryversusradicalresectionforearlystagerectalcancerasystematicreviewandmetaanalysis
AT caoyinghao transanalendoscopicmicrosurgeryversusradicalresectionforearlystagerectalcancerasystematicreviewandmetaanalysis
AT liutao transanalendoscopicmicrosurgeryversusradicalresectionforearlystagerectalcancerasystematicreviewandmetaanalysis