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Dis Colon Rectum. 2015 Feb;58(2):254-61. doi: 10.1097/DCR.0000000000000309.

Transanal endoscopic microsurgery versus standard transanal excision for the removal of rectal neoplasms: a systematic review and meta-analysis.

Author information

1
1Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland 2Center for Colon & Rectal Surgery, Florida Hospital, Orlando, Florida 3School of Medicine and Medical Sciences, University College Dublin, Ireland.

Abstract

BACKGROUND:

Transanal endoscopic microsurgery is the intraluminal excision of rectal lesions with the use of instrumentation to maintain a stable pneumorectum, enabling a magnified view of the target lesion. Despite suggested benefits over traditional transanal excision, there is no consensus on which technique is superior.

OBJECTIVE:

The aim of the current study is to use meta-analytical techniques to compare transanal endoscopic microsurgery with transanal excision.

DATA SOURCES:

A comprehensive literature search of PubMed, Embase, and The Cochrane Library was performed.

STUDY SELECTION:

All studies comparing transanal endoscopic microsurgery with transanal excision were included.

INTERVENTIONS:

Transanal endoscopic microsurgery was compared with transanal excision by using random-effects methods to combine data. Data are presented as ORs with 95% CIs.

MAIN OUTCOME MEASURES:

The main outcomes measured were postoperative complication rate, negative microscopic margin rate, specimen fragmentation rate, and lesion recurrence.

RESULTS:

Six comparative series comparing outcomes following 927 local excisions were identified. There was no difference between techniques in postoperative complication rate (OR, 1.018; 95% CI, 0.658-1.575; p = 0.937). Transanal endoscopic microsurgery had a higher rate of negative microscopic margins in comparison with transanal excision (OR, 5.281; 95% CI, 3.201-8.712; p < 0.001). Transanal endoscopic microsurgery had a reduced rate of specimen fragmentation (OR, 0.096; 95% CI, 0.044-0.209; p < 0.001) and lesion recurrence (OR, 0.248; 95% CI, 0.154-0.401; p < 0.001) compared with transanal excision. There was no across-study heterogeneity for any end point.

LIMITATIONS:

Most studies were retrospectively designed, and there were variations in patient populations and duration of follow-up.

CONCLUSIONS:

Available data are limited because of a lack of randomized controlled trials. However, based on current evidence, transanal endoscopic microsurgery is oncologically superior to transanal excision for the excision of rectal neoplasms.

PMID:
25585086
DOI:
10.1097/DCR.0000000000000309
[Indexed for MEDLINE]

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