Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - HC/FMUSP, Av. Dr. Enéas de Carvalho Aguiar, 255 - Instituto Central - Prédio dos Ambulatórios - Cerqueira César, São Paulo, SP, CEP: 05403-000, Brazil.
Division of Gastroenterology, Hepatology and Endoscopy, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
Surg Endosc. 2020 Mar;34(3):1025-1034. doi: 10.1007/s00464-019-07271-2. Epub 2019 Nov 21.
Minimally invasive treatment of early-stage rectal lesion has presented good results, with lower morbidity than surgical resection. Transanal endoscopic microsurgery (TEM) and transanal minimally invasive surgery (TAMIS) are the main methods of transanal surgery. However, endoscopic submucosal dissection (ESD) has been gaining ground because it allows en bloc resections with low recurrence rates. The aim of this study was to analyze ESD in comparison with transanal endoscopic surgery.
We searched MEDLINE, EMBASE, SciELO, Cochrane CENTRAL, and Lilacs/Bireme with no restrictions on the date or language of publication. The outcomes evaluated were recurrence rate, complete (R0) resection rate, en bloc resection rate, length of hospital stay, duration of the procedure, and complication rate.
Six retrospective cohort studies involving a collective total of 326 patients-191 in the ESD group and 135 in the transanal endoscopic surgery group were conducted. There were no statistically significant differences between the groups for any of the outcomes evaluated.
For the minimally invasive treatment of early rectal tumor, ESD and surgical techniques do not differ in terms of local recurrence, en bloc resection rate, R0 resection rate, duration of the procedure, length of hospital stay, or complication rate, however, evidence is very low.
微创治疗早期直肠病变已取得良好效果，其发病率低于手术切除。经肛门内镜微创手术（TEM）和经肛门微创外科（TAMIS）是经肛门手术的主要方法。然而，由于内镜黏膜下剥离术（ESD）可以整块切除且复发率低，因此其应用越来越广泛。本研究旨在分析 ESD 与经肛门内镜手术的疗效差异。
我们检索了 MEDLINE、EMBASE、SciELO、Cochrane CENTRAL 和 Lilacs/Bireme，未对发表日期或语言进行限制。评估的结局包括复发率、完全（R0）切除率、整块切除率、住院时间、手术时间和并发症发生率。
共纳入了 6 项回顾性队列研究，总计 326 例患者，ESD 组 191 例，经肛门内镜手术组 135 例。两组在任何评估结局方面均无统计学差异。
对于早期直肠肿瘤的微创治疗，ESD 与手术技术在局部复发率、整块切除率、R0 切除率、手术时间、住院时间或并发症发生率方面无差异，但证据质量非常低。
