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CC BY 4.0 · Surg J (N Y) 2021; 07(03): e241-e250
DOI: 10.1055/s-0041-1735587
Review Article

A Meta-analysis of Transanal Endoscopic Microsurgery versus Total Mesorectal Excision in the Treatment of Rectal Cancer

Nasir Zaheer Ahmad 
1   Department of Surgery, University Hospital Limerick, Limerick, Republic of Ireland
,
Muhammad Hasan Abbas
2   Department of Surgery, Russells Hall Hospital, NHS Trust, West Midlands, Dudley, United Kingdom
,
Mohamed H. Abunada
3   Department of Surgery, Hamad Medical Hospital, Doha, Qatar
,
Amjad Parvaiz
4   Faculty of Health Sciences, University of Portsmouth, Portsmouth, England
5   Department of Colorectal Surgery, Poole NHS Trust, Poole, United Kingdom
› Author Affiliations Funding None.
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Abstract

Background Transanal endoscopic microsurgery (TEMS) has been suggested as an alternative to total mesorectal excision (TME) in the treatment of early rectal cancers. The extended role of TEMS for higher stage rectal cancers after neoadjuvant therapy is also experimented. The aim of this meta-analysis was to compare the oncological outcomes and report on the evidence-based clinical supremacy of either technique.

Methods Medline, Embase, and Cochrane databases were searched for the randomized controlled trials comparing the oncological and perioperative outcomes of TEMS and a radical TME. A local recurrence and postoperative complications were analyzed as primary end points. Intraoperative blood loss, operation time, and duration of hospital stay were compared as secondary end points.

Results There was no statistical difference in the local recurrence or postoperative complications with a risk ratio of 1.898 and 0.753 and p-values of 0.296 and 0.306, respectively, for TEMS and TME. A marked statistical significance in favor of TEMS was observed for secondary end points. There was standard difference in means of −4.697, −6.940, and −5.685 with p-values of 0.001, 0.005, and 0.001 for blood loss, operation time, and hospital stay, respectively.

Conclusion TEMS procedure is a viable alternative to TME in the treatment of early rectal cancers. An extended role of TEMS after neoadjuvant therapy may also be offered to a selected group of patients. TME surgery remains the standard of care in more advanced rectal cancers.

Keywords

rectal cancer - microsurgery - total mesorectal excision

Ethical Approval

Not applicable.




Publication History

Received: 29 December 2020

Accepted: 22 July 2021

Article published online:
14 September 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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