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International Journal of Colorectal... Feb 2023In the treatment of early-stage rectal cancer, a growing number of studies have shown that transanal endoscopic microsurgery is one of the alternatives to radical... (Meta-Analysis)
Meta-Analysis
PURPOSE
In the treatment of early-stage rectal cancer, a growing number of studies have shown that transanal endoscopic microsurgery is one of the alternatives to radical surgery adhering to total mesorectal excision that can reduce the incidence of adverse events without compromising treatment outcomes. The purpose of this meta-analysis is to compare the safety and treatment effect of transanal endoscopic microsurgery and radical surgery adhering to total mesorectal excision to provide a basis for clinical treatment selections.
METHOD
We searched the literatures of four major databases, PubMed, Embase, Web of science, and Cochrane Library, without limitation of time. The literatures included randomized controlled studies and cohort studies comparing two surgical procedures of transanal endoscopic microsurgery and radical surgery adhering to total mesorectal excision. Treatment effectiveness and safety results of transanal endoscopic microsurgery and radical surgery were extracted from the included literatures and statistically analyzed using RevMan5.4 and stata17.
RESULT
Ultimately, 13 papers were included in the study including 5 randomized controlled studies and 8 cohort studies. The results of the meta-analysis showed that the treatment effect and safety of both transanal endoscopic microsurgery and radical surgery in distant metastasis (RR, 0.59 (0.34, 1.02), P > 0.05), overall recurrence (RR, 1.49 (0.96, 2.31), P > 0.05), disease-specific-survival (RR, 0.74 (0.09, 1.57), P > 0.05), dehiscence of the sutureline or anastomosis leakage (RR, 0.57 (0.30, 1.06), P > 0.05), postoperative bleeding (RR, 0.47 (0.22, 0.99), P > 0.05), and pneumonia (RR, 0.37, (0.10, 1.40), P > 0.05) were not significantly different. However, they differ significantly in perioperative mortality (RR, 0.26 (0.07, 0.93, P < 0.05)), local recurrence (RR, 2.51 (1.53, 4.21), P < 0.05),_overall survival_ (RR, 0.88 (0.74, 1.00), P < 0.05), disease-free-survival (RR, 1.08 (0.97, 1.19), P < 0.05), temporary stoma (RR, 0.05 (0.01, 0.20), P < 0.05), permanent stoma (RR, 0.16 (0.08, 0.33), P < 0.05), postoperative complications (RR, 0.35 (0.21, 0.59), P < 0.05), rectal pain (RR, 1.47 (1.11, 1.95), P < 0.05), operation time (RR, -97.14 (-115.81, -78.47), P < 0.05), blood loss (RR, -315.52 (-472.47, -158.57), P < 0.05), and time of hospitalization (RR, -8.82 (-10.38, -7.26), P < 0.05).
CONCLUSION
Transanal endoscopic microsurgery seems to be one of the alternatives to radical surgery for early-stage rectal cancer, but more high-quality clinical studies are needed to provide a reliable basis.
Topics: Humans; Microsurgery; Neoplasm Staging; Rectal Neoplasms; Rectum; Retrospective Studies; Transanal Endoscopic Microsurgery; Treatment Outcome
PubMed: 36800079
DOI: 10.1007/s00384-023-04341-9 -
Diseases of the Colon and Rectum Feb 2015Transanal endoscopic microsurgery is the intraluminal excision of rectal lesions with the use of instrumentation to maintain a stable pneumorectum, enabling a magnified... (Comparative Study)
Comparative Study Meta-Analysis Review
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.
Topics: Adenoma; Carcinoma; Disease-Free Survival; Humans; Microsurgery; Proctoscopy; Rectal Neoplasms; Rectum; Treatment Outcome
PubMed: 25585086
DOI: 10.1097/DCR.0000000000000309 -
Colorectal Disease : the Official... May 2024Restorative proctocolectomy with transabdominal ileal pouch-anal anastomosis (abd-IPAA) has become the standard surgical treatment for medically refractory ulcerative... (Meta-Analysis)
Meta-Analysis Review
AIM
Restorative proctocolectomy with transabdominal ileal pouch-anal anastomosis (abd-IPAA) has become the standard surgical treatment for medically refractory ulcerative colitis (UC). However, it requires a technically difficult distal anorectal dissection and anastomosis due to the bony confines of the deep pelvis. To address these challenges, the transanal IPAA approach (ta-IPAA) was developed. This novel approach may offer increased visibility and range of motion compared with abd-IPAA, although its postoperative benefits remain unclear. The aim of this work was to perform a systematic review and meta-analysis to compare and inform the frequency of postoperative outcomes between ta-IPAA and abd-IPAA for patients with UC.
METHOD
Several databases were searched from inception until May 2022 for studies reporting postoperative outcomes of patients undergoing ta-IPAA. Reviewers, working independently and in duplicate, evaluated studies for inclusion and graded the risk of bias. Odds ratios (OR), mean differences (MD) and prevalence ratio (PR) and their corresponding 95% confidence intervals (CIs) were calculated using random-effects models. Sensitivity analysis was performed.
RESULTS
Ten retrospective studies comprising 284 patients with ta-IPAA were included. Total mesorectal excision was performed in 61.8% of cases and close rectal dissection in 27.9%. There was no difference in the odds of Clavien-Dindo (CD) I-II complications, CD III-IV and anastomotic leak (OR 0.96, 95% CI 0.27-3.40; OR 1.18, 95% CI 0.65-2.16; OR 1.37, 95% CI 0.58-3.23; respectively) between ta-IPAA and abd-IPAA. The ta-IPAA pooled CD I-II complication rate was 18% (95% CI 5%-35%) and for CD III-IV 10% (95% CI 5%-17%), and the anastomotic leak rate was 6% (95% CI 2%-10%). There were no deaths reported.
CONCLUSIONS
This meta-analysis compared the novel ta-IPAA procedure with abd-IPAA and found no difference in postoperative outcomes. While the need for randomized controlled trails and comparison of functional outcomes between both approaches remains, this evidence should assist colorectal surgeons to decide if ta-IPAA is a viable alternative.
Topics: Humans; Proctocolectomy, Restorative; Colitis, Ulcerative; Postoperative Complications; Treatment Outcome; Colonic Pouches; Anal Canal; Female; Male; Adult; Retrospective Studies; Middle Aged; Anastomosis, Surgical; Anastomotic Leak; Transanal Endoscopic Surgery; Inflammatory Bowel Diseases
PubMed: 38594838
DOI: 10.1111/codi.16977 -
Diseases of the Colon and Rectum Sep 2009Transanal hemorrhoidal dearterialization consists of a Doppler-guided ligation of the distal branches of the rectal arteries. The aim of this review is to assess the... (Review)
Review
PURPOSE
Transanal hemorrhoidal dearterialization consists of a Doppler-guided ligation of the distal branches of the rectal arteries. The aim of this review is to assess the current evidence on dearterialization, establish the safety and efficacy of the technique, define its indications, and identify its possible advantages and limitations.
METHODS
All published studies on dearterialization without language restrictions were reviewed systematically. Primary outcome measures were postoperative pain and hemorrhoidal recurrences.
RESULTS
Seventeen articles including a total of 1,996 patients were analyzed. In general, the quality of the studies was low. Operating time ranged between 5 and 50 minutes. Hospital stay was one day for most patients, whereas the return to normal activities was between two and three days in most cases. Postoperative pain was present in 18.5% of patients. Three patients experienced significant postoperative hemorrhages. There were no other major complications. The overall recurrence rate was 9.0% for prolapse, 7.8% for bleeding, and 4.7% for pain at defecation. The recurrence rate at one year or more was 10.8% for prolapse, 9.7% for bleeding, and 8.7% for pain at defecation. When reported as a function of the hemorrhoidal grade, the recurrence rate was higher for fourth-degree hemorrhoids (range, 11.1-59.3%).
CONCLUSION
Transanal hemorrhoidal dearterialization appears to be a potential treatment option for second-degree and third-degree hemorrhoids. Clinical trials and longer follow-up comparing it with other procedures used to treat hemorrhoids are needed to establish a possible role for this technique.
Topics: Anal Canal; Hemorrhoids; Humans; Ligation; Proctoscopy; Suture Techniques
PubMed: 19690499
DOI: 10.1007/DCR.0b013e3181af50f4 -
Surgical Endoscopy May 2022Transanal total mesorectal excision (TaTME) appears to have favorable surgical and pathological outcomes. However, the evidence on survival outcomes remains unclear. We... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Transanal total mesorectal excision (TaTME) appears to have favorable surgical and pathological outcomes. However, the evidence on survival outcomes remains unclear. We performed a meta-analysis to compare long-term oncologic outcomes of TaTME with transabdominal TME for rectal cancer.
METHODS
PubMed, EMBASE, and the Cochrane Library were searched. Data were pooled, and overall effect size was calculated using random-effects models. Outcome measures were overall survival (OS), disease-free survival (DFS), and local and distant recurrence.
RESULTS
We included 11 nonrandomized studies that examined 2,143 patients for the meta-analysis. There were no significant differences between the two groups in OS, DFS, and local and distant recurrence with a RR of 0.65 (95% CI 0.39-1.09, I = 0%), 0.79 (95% CI 0.57-1.10, I = 0%), 1.14 (95% CI 0.44-2.91, I = 66%), and 0.75 (95% CI 0.40-1.41, I = 0%), respectively.
CONCLUSION
In terms of long-term oncologic outcomes, TaTME may be an alternative to transabdominal TME in patients with rectal cancer. Well-designed randomized trials are warranted to further verify these results.
Topics: Humans; Laparoscopy; Postoperative Complications; Rectal Neoplasms; Rectum; Transanal Endoscopic Surgery; Treatment Outcome
PubMed: 34169371
DOI: 10.1007/s00464-021-08615-7 -
Techniques in Coloproctology Mar 2018Multiple studies have demonstrated the benefits of laparoscopic colorectal surgery (LCS), but in several countries it has still not been widely adopted. LCS training is... (Review)
Review
Multiple studies have demonstrated the benefits of laparoscopic colorectal surgery (LCS), but in several countries it has still not been widely adopted. LCS training is associated with several challenges, such as patient safety concerns and a steep learning curve. Current evidence may facilitate designing of efficient training curricula to overcome these challenges. Basic training with virtual reality simulators has witnessed meteoric advances and may be essential during the early parts of the learning curve. Cadaveric and animal model training still constitutes an indispensable training tool, due to a higher degree of difficulty and greater resemblance to real operative conditions. In addition, recent evidence favors the use of novel training paradigms, such as proficiency-based training, case selection and modular training. This review summarizes the recent advances in LCS training and provides the evidence for designing an efficient training curriculum to overcome the challenges of LCS training.
Topics: Cadaver; Colorectal Surgery; Curriculum; Educational Measurement; Humans; Internship and Residency; Laparoscopy; Learning Curve; Models, Animal; Patient Safety; Robotic Surgical Procedures; Simulation Training; Transanal Endoscopic Surgery; Virtual Reality
PubMed: 29512045
DOI: 10.1007/s10151-018-1760-y -
Techniques in Coloproctology Dec 2017Transanal local excision (TLE) has become the treatment of choice for benign and early-stage selected malignant tumors. However, closure of the rectal wall defect... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Transanal local excision (TLE) has become the treatment of choice for benign and early-stage selected malignant tumors. However, closure of the rectal wall defect remains a controversial point and the available literature still remains unclear. Our aim was to determine through a systematic review of the literature and a meta-analysis of relevant studies whether or not the wall defect following TLE of rectal tumors should be closed.
METHODS
Medline and the Cochrane Trials Register were searched for trials published up to December 2016 comparing open versus closed management of the surgical rectal defect after TLE of rectal tumors. Meta-analysis was performed using Review Manager 5.0.
RESULTS
Four studies were analyzed, yielding 489 patients (317 in the closed group and 182 in the open group). Meta-analysis showed no significant difference between the closed and open groups regarding the overall morbidity rate (OR 1.26; 95% CI 0.32-4.91; p = 0.74), postoperative local infection rate (OR 0.62; 95% CI 0.23-1.62; p = 0.33), postoperative bleeding rate (OR 0.83; 95% CI 0.29-1.77; p = 0.63), and postoperative reintervention rate (OR 2.21; 95% CI 0.52-9.47; p = 0.29).
CONCLUSIONS
This review and meta-analysis suggest that there is no difference between closure or non-closure of wall defects after TLE.
Topics: Humans; Postoperative Hemorrhage; Rectal Neoplasms; Reoperation; Surgical Wound Infection; Transanal Endoscopic Surgery; Wound Closure Techniques
PubMed: 29134387
DOI: 10.1007/s10151-017-1714-9 -
Surgical Endoscopy Apr 2020While multiple studies have evaluated endoscopic submucosal dissection (ESD) and transanal endoscopic microsurgery (TEM) to remove large rectal tumors, there remains a... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
While multiple studies have evaluated endoscopic submucosal dissection (ESD) and transanal endoscopic microsurgery (TEM) to remove large rectal tumors, there remains a paucity of data to evaluate their comparative efficacy and safety. The primary aim of this study was to perform a structured systematic review and meta-analysis to compare efficacy and safety of ESD versus TEM for the treatment of rectal tumors.
METHODS
Individualized search strategies were developed from inception through November 2018 in accordance with PRISMA guidelines. Measured outcomes included pooled enbloc resection rates, margin-negative (R) resection rates, procedure-associated adverse events, and rates of recurrence. This was a cumulative meta-analysis performed by calculating pooled proportions. Heterogeneity was assessed with Cochran Q test and I statistics, and publication bias by funnel plot using Egger and Begg tests.
RESULTS
Three studies (n = 158 patients; 55.22% male) were included in this meta-analysis. Patients with ESD compared to TEM had similar age (P = 0.090), rectal tumor size (P = 0.108), and diagnosis rate of adenoma to cancer (P = 0.53). ESD lesions were more proximal as compared to TEM (8.41 ± 3.49 vs. 5.11 ± 1.43 cm from the anal verge; P < 0.001). Procedure time and hospital stay were shorter for ESD compared to TEM [(79.78 ± 24.45 vs. 116.61 ± 19.35 min; P < 0.001) and (3.99 ± 0.32 vs. 5.83 ± 0.94 days; P < 0.001), respectively]. No significant differences between enbloc resection rates [OR 0.98 (95% CI 0.22-4.33); P = 0.98; I = 0.00%] and R resection rates [OR 1.16 (95% CI 0.36-3.76); P = 0.80; I = 0.00%] were noted between ESD and TEM. ESD and TEM reported similar rates of adverse events [OR 1.15 (95% CI 0.47-2.77); P = 0.80; I = 0.00%] and rates of recurrence [OR 0.46 (95% CI 0.07-3.14); P = 0.43; I = 0.00%].
CONCLUSION
ESD and TEM possess similar rates of resection, adverse events, and recurrence for patients with large rectal tumors; however, ESD is associated with significantly shorter procedure times and duration of hospitalization. Future studies are needed to evaluate healthcare utilization for these two strategies.
Topics: Adenoma; Anal Canal; Comparative Effectiveness Research; Endoscopic Mucosal Resection; Female; Humans; Length of Stay; Male; Margins of Excision; Middle Aged; Neoplasm Recurrence, Local; Operative Time; Postoperative Complications; Rectal Neoplasms; Rectum; Transanal Endoscopic Microsurgery; Treatment Outcome
PubMed: 31292744
DOI: 10.1007/s00464-019-06945-1 -
Diseases of the Colon and Rectum Feb 2005The aim of this study was to systematically review the evidence relating to the safety and efficacy of transanal endoscopic microsurgery, a relatively new technique used... (Review)
Review
PURPOSE
The aim of this study was to systematically review the evidence relating to the safety and efficacy of transanal endoscopic microsurgery, a relatively new technique used to locally excise rectal tumors, compared with existing techniques such as anterior resections and abdominoperineal resections or local excisions.
METHODS
We conducted a systematic review of comparative studies and case series of transanal endoscopic microsurgery from 1980 to August 2002.
RESULTS
Three comparative studies (including one randomized, controlled trial) and 55 case series were included. The first area of study was the safety and efficacy of adenomas. In the randomized, controlled trial, no difference could be detected in the rate of early complications between transanal endoscopic microsurgery (10.3 percent) and direct local excision (17 percent) (relative risk, 0.61; 95 percent confidence interval, 0.29-1.29). Transanal endoscopic microsurgery resulted in less local recurrence (6/98; 6 percent) than direct local excision (20/90; 22 percent) (relative risk, 0.28; 95 percent confidence interval, 0.12-0.66). The 6 percent rate of local recurrence for transanal endoscopic microsurgery in this trial is consistent with the rates found in case series of transanal endoscopic microsurgery (median, 5 percent). The second area of study was the safety and efficacy of carcinomas. In the randomized, controlled trial, no difference could be detected in the rate of complications between transanal endoscopic microsurgery and direct local excision (relative risk for overall early complication rates, 0.56; 95 percent confidence interval, 0.22-1.42). No differences in survival or local recurrence rate between transanal endoscopic microsurgery and anterior resection could be detected in either the randomized, controlled trial (hazard ratio,1.02 for survival) or the nonrandomized, comparative study. There were 2 of 25 (8 percent) transanal endoscopic microsurgery recurrences in the randomized, controlled trial, but no figures were given for recurrence after anterior resection. In the case series, the median local recurrence rate for transanal endoscopic microsurgery was 8.4 percent, ranging from 0 percent to 50 percent. The third comparison was cost of the procedures. Transanal endoscopic microsurgery had both a lower recurrence rate and a lower cost than local excision or anterior resection for adenomas. Although the effectiveness of transanal endoscopic microsurgery could not be established for carcinomas, costs were lower than those for either anterior resection or abdominoperineal resection.
CONCLUSIONS
The evidence regarding transanal endoscopic microsurgery is very limited, being largely based on a single relatively small randomized, controlled trial. However, transanal endoscopic microsurgery does appear to result in fewer recurrences than those with direct local excision in adenomas and thus may be a useful procedure for several small niches of patient types--e.g., for large benign lesions of the middle to upper third of the rectum, for T1 low-risk rectal cancers, and for palliative, not curative, use in more advanced tumors.
Topics: Anal Canal; Humans; Microsurgery; Proctoscopy; Rectal Neoplasms
PubMed: 15711865
DOI: 10.1007/s10350-004-0804-8 -
The Gulf Journal of Oncology Jan 2021Transanal total mesorectal excision (TaTME) is a new technique that is designed to overcome the limits encountered during laparoscopic total mesorectal excision (LaTME)... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Transanal total mesorectal excision (TaTME) is a new technique that is designed to overcome the limits encountered during laparoscopic total mesorectal excision (LaTME) for rectal cancer, especially in male, obese patients with a narrow pelvis and mid and low rectal tumours.
AIM
The objective of our meta-analysis is to evaluate short-term oncological and perioperative outcomes of transanal total mesorectal excision (TaTME) compared to laparoscopic total mesorectal excision (LaTME) for rectal cancer.
METHODS
A meta-analysis based on Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was conducted in MEDLINE (PubMed). All original studies published in English that compared TaTME with laTME were included. The quality of the included studies was assessed by the Newcastle- Ottawa Quality Assessment Scale (NOS) and Cochrane Library Handbook 5.1.0. Data analysis was conducted using the Review Manager 5.3 software.
RESULTS
Twelve studies including 835 TaTME patients and 1707 LaTME patients with rectal cancer met the inclusion criteria in this meta-analysis. No statistical significant differences were observed in regard to positive circumferential resection margin (PCRM), positive distal resection margin (PDRM), macroscopic quality of mesorectum (MQM) and harvested lymph nodes (HLN). Concerning the perioperative outcomes, the results of conversion rates, operative time, hospital stay (HS), anastomotic leakage (AL) and postoperative complications were comparable between the two groups.
CONCLUSION
Our meta-analysis provides that TaTME may be a valid alternative approach for the treatment of rectal cancer in comparison with LaTME.
Topics: Anastomotic Leak; Female; Humans; Male; Rectal Neoplasms; Transanal Endoscopic Surgery; Treatment Outcome
PubMed: 33716215
DOI: No ID Found