Skip to main content

Advertisement

SpringerLink
Log in

Outcomes of Transanal Endoscopic Microsurgery for T1 and T2 rectal cancer

  • Meta-Analysis
  • Published:
Hellenic Journal of Surgery

Abstract

Aim-Background

The objective was to evaluate Transanal Endoscopic Microsurgery as a surgical strategy for stage I rectal cancer and its associated perioperative morbidity and oncologic outcomes.

Methods

The present meta-analysis pooled the effects of outcomes of 986 patients enrolled in 3 randomized controlled trials, 1 prospective and 6 retrospective comparative studies.

Results

The Meta-analysis revealed an advantage to Transanal Endoscopic Microsurgery over Standard Resection in lessening the number of patients presenting with major (O.R= 0,24 (0,07–0,91) and overall postoperative complications (O.R= 0,16 (0,06–0,38) and prolonging the disease-free survival (O.R= 0,46 (0,24–0,88). On the contrary, Standard Resection was superior in terms of the number of patients with positive margins (O.R= 6,49 (1,49–24,91), local recurrence (O.R= 4,92 (1,81–13,41) and overall (local and distant recurrence: O.R= 2,03 (1,15–3,57). No survival advantage was observed in favour of either procedure. The number of patients with positive margins was less in Transanal Endoscopic Microsurgery when compared to Transanal Excision whilst the reverse applied to the disease-free survival.

Conclusions

In selected cases of early rectal cancer Transanal Endoscopic Microsurgery is superior to Standard Resection concerning morbidity and disease- free survival whilst the reverse applies to positive surgical margins, local and overall recurrence. No survival advantage was observed in favour of either procedure. Taking into consideration the comparison of Transanal Endoscopic Microsurgery versus Transanal Excision, Transanal Endoscopic Microsurgery performs better for negative surgical margins, whereas Transanal Excision shows a greater disease-free survival.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Buess G, Theiss R, Gunther M, Hutterer F, Pichlmaier H. Endoscopic surgery in the rectum. Endoscopy 1985;17:31–35.

    Article  CAS  PubMed  Google Scholar 

  2. Doornebosch PG, Tollenaar RA, Gosselink MP, Stassen LP, Dijkhuis CM, Schouten WR, van de Velde CJ, de Graaf EJ. Quality of life after transanal endoscopic microsurgery and total mesorectal excision in early rectal cancer. Colorectal Dis 2007;9:553–558.

    Article  CAS  PubMed  Google Scholar 

  3. Nelson H, Petrelli N, Carlin A, Couture J, Fleshman J, Guillem J, Miedema B, Ota D, Sargent D. Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst 2001;93:583–596.

    Article  CAS  PubMed  Google Scholar 

  4. Bentrem DJ, Okabe S, Wong WD, Guillem JG, Weiser MR, Temple LK, Ben-Porat LS, Minsky BD, Cohen AM, Paty PB. T 1 adenocarcinoma of the rectum: transanal excision or radical surgery? Ann Surg 2005;242:472–477; discussion 7–9.

    PubMed  Google Scholar 

  5. Mellgren A, Sirivongs P, Rothenberger DA, Madoff RD, Garcia-Aguilar J. Is local excision adequate therapy for early rectal cancer? Dis Colon Rectum 2000;43:1064–1071; discussion 71–4.

    Article  CAS  PubMed  Google Scholar 

  6. Bretagnol F, Rullier E, George B, Warren BF, Mortensen NJ. Local therapy for rectal cancer: still controversial? Dis Colon Rectum 2007;50:523–533.

    Article  CAS  PubMed  Google Scholar 

  7. Middleton PF, Sutherland LM, Maddern GJ. Transanal endoscopic microsurgery: a systematic review. Dis Colon Rectum 2005;48:270–284.

    Article  PubMed  Google Scholar 

  8. Doornebosch PG, Tollenaar RA, De Graaf EJ. Is the increasing role of Transanal Endoscopic Microsurgery in curation for T1 rectal cancer justified? A systematic review. Acta Oncol 2009;48:343–353.

    Article  PubMed  Google Scholar 

  9. Christoforidis D, Cho HM, Dixon MR, Mellgren AF, Madoff RD, Finne CO. Transanal endoscopic microsurgery versus conventional transanal excision for patients with early rectal cancer. Ann Surg 2009;249:776–782.

    Article  PubMed  Google Scholar 

  10. Moore JS, Cataldo PA, Osler T, Hyman NH. Transanal endoscopic microsurgery is more effective than traditional transanal excision for resection of rectal masses. Dis Colon Rectum 2008;51:1026–1030; discussion 30–1.

    Article  PubMed  Google Scholar 

  11. De Graaf EJ, Doornebosch PG, Tollenaar RA, Meershoek-Klein Kranenbarg E, de Boer AC, Bekkering FC, van de Velde CJ. Transanal endoscopic microsurgery versus total mesorectal excision of T1 rectal adenocarcinomas with curative intention. Eur J Surg Oncol 2009;35:1280–1285.

    PubMed  Google Scholar 

  12. Langer C, Liersch T, Suss M, Siemer A, Markus P, Ghadimi BM, Fuzesi L, Becker H. Surgical cure for early rectal carcinoma and large adenoma: transanal endoscopic microsurgery (using ultrasound or electrosurgery) compared to conventional local and radical resection. Int J Colorectal Dis 2003;18:222–229.

    CAS  PubMed  Google Scholar 

  13. Palma P, Horisberger K, Joos A, Rothenhoefer S, Willeke F, Post S. Local excision of early rectal cancer: is transanal endoscopic microsurgery an alternative to radical surgery? Rev Esp Enferm Dig 2009;101:172–178.

    Article  CAS  PubMed  Google Scholar 

  14. Heintz A, Morschel M, Junginger T. Comparison of results after transanal endoscopic microsurgery and radical resection for T1 carcinoma of the rectum. Surg Endosc 1998;12:1145–1148.

    Article  CAS  PubMed  Google Scholar 

  15. Lee W, Lee D, Choi S, Chun H. Transanal endoscopic microsurgery and radical surgery for T1 and T2 rectal cancer. Surg Endosc 2003;17:1283–1287.

    Article  CAS  PubMed  Google Scholar 

  16. Lezoche G, Baldarelli M, Guerrieri M, Paganini AM, De Sanctis A, Bartolacci S, Lezoche E. A prospective randomized study with a 5-year minimum follow-up evaluation of transanal endoscopic microsurgery versus laparoscopic total mesorectal excision after neoadjuvant therapy. Surg Endosc 2008;22:352–358.

    Article  CAS  PubMed  Google Scholar 

  17. Winde G, Nottberg H, Keller R, Schmid KW, Bunte H. Surgical cure for early rectal carcinomas (T1). Transanal endoscopic microsurgery vs. anterior resection. Dis Colon Rectum 1996;39:969–976.

    Article  CAS  PubMed  Google Scholar 

  18. Dixon MR, Finne CO, Madoff RD, Goldberg J, Mellgren A, Alavi K. Transanal endoscopic microsurgery (TEM) improves outcome in local treatment of early rectal cancer. Dis Colon Rectum 2006;49:715–716.

    Google Scholar 

  19. Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses. Lancet 1999;354:1896–1900.

    Article  CAS  PubMed  Google Scholar 

  20. Mahid SS, Hornung CA, Minor KS, Turina M, Galandiuk S. Systematic reviews and meta-analysis for the surgeon scientist. Br J Surg 2006;93:1315–1324.

    Article  CAS  PubMed  Google Scholar 

  21. Egger. M, Smith. G D, Altman. D G. Systematic Reviews in Health Care: Meta-analysis in Context (2nd edn).. BMJ Books: London 2001.

    Google Scholar 

  22. Review Manager (RevMan) [Computer program]. Version 5.0. Copenhagen: The Nordic Cochrane Centre TCC, 2008.

  23. Higgins JPT Green S editors. Cochrane Handbook for Systematic Reviews of Interventions 4.2.6 6 [updated September 2006]. In: The Cochrane Library I, 2006. Chichester, UK: John Wiley & Sons, Ltd.

  24. Zamora. J, Abraira. V, Muriel. A. Meta-DiSc: a software for meta-analysis of test accuracy data BMC Medical Research Methodology 2006;6:31.

    Google Scholar 

  25. Rosenberg MS, Adams D. C., Gurevitch J. 2000. MetaWin. Statistical software for meta-analysis. Version 2. Sinauer Asociates, Sunderland, Massachusetts.

    Google Scholar 

  26. Available at: www.myhamilton.ca/myhamilton/cityandgovernment/healthandsocialservices/research/ephpp/ephpp.htm <http://www.myhamilton.ca/myhamilton/cityandgovernment/healthandsocialservices/research/ephpp/ephpp.htm>

  27. Lezoche E, Guerrieri M, Paganini AM, D’Ambrosio G, Baldarelli M, Lezoche G, Feliciotti F, De Sanctis A. Transanal endoscopic versus total mesorectal laparoscopic resections of T2-N0 low rectal cancers after neoadjuvant treatment: a prospective randomized trial with a 3-years minimum follow-up period. Surg Endosc 2005;19:751–756.

    Article  CAS  PubMed  Google Scholar 

  28. Balani A, Turoldo A, Braini A, Scaramucci M, Roseano M, Leggeri A. Local excision for rectal cancer. J Surg Oncol 2000;74:158–162.

    Article  CAS  PubMed  Google Scholar 

  29. Mahmoud N, Madoff R, Rothenberger D, Finne C. Transanal endoscopic microsurgery (TEM) reduces the incidence of positive margins compared with transanal excision for rectal tumours. Dis Colon Rectum 2001;44.

  30. Deeks JJ, Macaskill P, Irwig L. The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol 2005;58:882–893.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. 2nd Surgical Department and Surgical Oncology Unit of “Korgialenio — Benakio”, Red Cross Hospital, Athens, Greece

    G. Sgourakis, S. Lanitis, Chr. Kontovounisios, V. Armoutidis, M. Korontzi, C. Zacharioudakis & C. Karaliotas

Authors
  1. G. Sgourakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Lanitis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chr. Kontovounisios
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. V. Armoutidis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Korontzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C. Zacharioudakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. C. Karaliotas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. Sgourakis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sgourakis, G., Lanitis, S., Kontovounisios, C. et al. Outcomes of Transanal Endoscopic Microsurgery for T1 and T2 rectal cancer. Hellenic J Surg 82, 161–171 (2010). https://doi.org/10.1007/s13126-010-0028-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13126-010-0028-4

Keywords

Search

Navigation