Systematic review and meta-analysis of local resection or transanal endoscopic microsurgery versus radical resection in stage i rectal cancer: A real standard?. (June 2017)

• Record Type: Journal Article
• Authors: Veereman, Geneviève; Vlayen, Joan; Robays, Jo; Fairon, Nicolas; Stordeur, Sabine; Rolfo, Christian; Bielen, Didier; Bols, Alain; Demetter, Pieter; D'hoore, André; Haustermans, Karin; Hendlisz, Alain; Lemmers, Arnaud; Leonard, Daniel; Penninckx, Freddy; Van Cutsem, Eric; Peeters, Marc
• Is Part Of: Critical reviews in oncology/hematology. Volume 114(2017)
• Page Start: 43
• Page End: 52
• Publication Date: 2017-06
• Subjects: AR Abdominal resection -- CI Confidence interval -- DFS Disease free survival -- ESD Endoscopic submucosal dissection -- ESGE European Society of Gastrointestinal Endoscopy -- ITT Intention-to-treat -- KCE Belgian Health Care Knowledge Centre -- LR Local recurrence -- LRFS Local recurrence free survival -- MA Meta-analysis -- MRI Magnetic resonance imaging -- NCCN National Comprehensive Cancer Network -- NICE National Institute for Health and Care Excellence -- OR Odds ratio -- OS Overall survival -- PICO Population-intervention-comparator-outcome -- PRISMA Preferred reporting items for systematic reviews and meta-analysis -- QoL Quality of life -- RCT Randomised controlled trial -- RR Risk ratio -- SR Systematic review -- TAE Transanal excision -- TEM(S) Transanal endoscopic microsurgery -- TME Total mesorectal excision; Rectum -- Cancer -- Stage I -- Resection -- Surgery -- Transanal excision -- Transanal endoscopic microsurgery -- Total mesorectal excision; Oncology -- Periodicals; Hematology -- Periodicals; 616.994
• DOI: 10.1016/j.critrevonc.2017.03.008
• Languages: English
• ISSNs: 1040-8428

Abstract

Abstract: Current guidelines recommend radical resection for stage I rectal cancer. However, since screening programs are being installed, an increasing number of cancers are being detected in early stages. Endoscopic resection is often performed at the time of diagnosis. This systematic review was undertaken to review the evidence on endoscopic approach vs. radical resection for stage I rectal cancer. Recommendations were issued based on the GRADE methodology and risk stratification used in clinical practice. A systematic search (until March 2015) identified 2 meta-analyses and 1 additional randomized trial. For the primary outcomes (overall survival, disease-free survival, local recurrence-free survival and metastasis-free survival) no evidence could be found on the superiority of local or radical resection. Secondary outcomes (blood loss, hospital stay, operative time, number of permanent stomas and perioperative deaths) were in favour of local resection. The authors strongly recommend radical resection for T2 rectal cancer, but consider 'en bloc' local resection sufficient for pT1 sm1 rectal cancers when confirmed pathologically. Discussion by a multidisciplinary team and adequate surveillance remain mandatory.