AB031. SOH23ABS_203. A systematic review and network meta-analysis of minimally invasive approaches to the management of early rectal neoplasms
General Surgery I Session

AB031. SOH23ABS_203. A systematic review and network meta-analysis of minimally invasive approaches to the management of early rectal neoplasms

Mark Donnelly, Ailish Naughton, Maria Whelan, Paul Neary, James O’Riordain, Dara Kavanagh

Department of Surgery, Tallaght University Hospital, Dublin, Ireland

Background: Several minimally invasive techniques have developed over the recent past for curative management of early rectal cancer (ERC). However, an optimal approach with regards to both oncological outcomes and associated morbidity remains unclear.

Methods: A systematic literature search was conducted comparing studies with at least two of the above techniques. A network meta-analysis with a frequentist framework was then performed. Endoscopic mucosal resection (EMR) was then used as a baseline comparator. The pre-specified primary outcomes were; en bloc resection, R0 resection and recurrence rates.

Results: The analysis included 40 papers, with 4,620 patients included. All included techniques had higher en bloc excision rates versus EMR. Higher R0 resection rates were noted with both; endoscopic submucosal dissection (ESD) (OR 1.79; 95% CI: 1.08–2.97) and transanal endoscopic microsurgery (TEMS) (OR 2.78; 95% CI: 1.22–6.36). TEMS (OR 0.28, 95% CI: 0.11–0.71) and transanal minimally invasive surgery (TAMIS) (OR 0.22; 95% CI: 0.06–0.84) had reduced recurrence rates versus EMR. Increased duration of surgery was observed with TEMS (MD 20.96; 95% CI: 5.91–36.00 minutes) and ESD (MD 10.7; 95% CI: 3.9–17.5 minutes). ESD, transanal excision (TAE) and TEMS were associated with an increased duration of in-hospital stay compared to EMR and TAMIS.

Conclusions: EMR had the worst en bloc resection rate of all evaluated techniques for excision of ERC. TEMS and TAMIS displayed improved recurrence free rates compared to endoscopic techniques and TAE for ERC. The potential oncologic benefit of TEMS and TAMIS for ERC would suggest these findings should be investigated in prospective studies of higher methodological quality and larger patient cohort.

Keywords: Endoscopic mucosal resection (EMR); endoscopic submucosal dissection (ESD); transanal surgery; early rectal cancer (ERC); minimally invasive surgery

Acknowledgments

Funding: None.

Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-23-ab031
Cite this abstract as: Donnelly M, Naughton A, Whelan M, Neary P, O’Riordain J, Kavanagh D. AB031. SOH23ABS_203. A systematic review and network meta-analysis of minimally invasive approaches to the management of early rectal neoplasms. Mesentery Peritoneum 2023;7:AB031.

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