Transanal Endoscopic Microsurgery Versus Standard Transanal Excision for the Removal of Rectal Neoplasms. Issue 2 (February 2015)

• Record Type: Journal Article
• Authors: Clancy, Cillian; Burke, John P.; Albert, Mathew R.; O'Connell, P. Ronan; Winter, Desmond C.
• Is Part Of: Diseases of the colon & rectum. Volume 58:Issue 2(2015:Feb.)
• Publication Date: 2015-02
• Subjects: Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; Colonic Diseases -- Periodicals; Colorectal Surgery -- Periodicals; 616.34
• DOI: 10.1097/DCR.0000000000000309
• Languages: English
• ISSNs: 0012-3706

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>BACKGROUND:</title> <p>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.</p> </sec> <sec> <title>OBJECTIVE:</title> <p>The aim of the current study is to use meta-analytical techniques to compare transanal endoscopic microsurgery with transanal excision.</p> </sec> <sec> <title>DATA SOURCES:</title> <p>A comprehensive literature search of PubMed, Embase, and The Cochrane Library was performed.</p> </sec> <sec> <title>STUDY SELECTION:</title> <p>All studies comparing transanal endoscopic microsurgery with transanal excision were included.</p> </sec> <sec> <title>INTERVENTIONS:</title> <p>Transanal endoscopic microsurgery was compared with transanal excision by using random-effects methods to combine data. Data are presented as ORs with 95% CIs.</p> </sec> <sec> <title>MAIN OUTCOME MEASURES:</title> <p>The main outcomes measured were postoperative complication rate, negative microscopic margin rate, specimen fragmentation rate, and lesion recurrence.</p> </sec> <sec> <title>RESULTS:</title> <p>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; <italic>p</italic> = 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; <italic>p</italic> < 0.001). Transanal endoscopic microsurgery had a reduced rate of specimen fragmentation (OR, 0.096; 95% CI, 0.044–0.209; <italic>p</italic> < 0.001) and lesion recurrence (OR, 0.248; 95% CI, 0.154–0.401; <italic>p</italic> < 0.001) compared with transanal excision. There was no across-study heterogeneity for any end point.</p> </sec> <sec> <title>LIMITATIONS:</title> <p>Most studies were retrospectively designed, and there were variations in patient populations and duration of follow-up.</p> </sec> <sec> <title>CONCLUSIONS:</title> <p>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.</p> </sec> </abstract>