Dąbkowski Krzysztof, Skonieczna-Żydecka Karolina, Gaweł Katarzyna, Marlicz Wojciech, Szredzki Piotr, Białek Andrzej
Department of Gastroenterology, Pomeranian Medical University in Szczecin, Szczecin, Poland.
Department of Biochemical Science, Pomeranian Medical University in Szczecin, Szczecin, Poland.
Clin Transl Gastroenterol. 2025 Jul 1. doi: 10.14309/ctg.0000000000000882.
Rectal neuroendocrine tumors (rNETs) are subepithelial lesions with potential of malignancy. Despite the guidelines recommending that rNETs measuring 10-20 mm should be removed either endoscopic submucosal dissection (ESD) or transanal endoscopic microsurgery (TEM), the management with these entities is still a clinical dilemma. We performed a meta-analysis to compare ESD and TEM regarding method effectiveness and safety in the treatment of rNETs.
PubMed/MEDLINE/Embase/EBSCO/CINAHL was searched up for observational studies analyzing the efficacy and safety of both methods in the treatment of rNETs.
A total of 59 observational studies with a total of n = 2,804 participants were included. In a subgroup analysis, we demonstrated that the R0 resection rate was significantly ( P = 0.002) lower for ESD (rate: 0.854) than for TEM (0.924). The recurrence rate differed significantly ( P = 0.008); the lowest (event rate [ER] = 0.015) was found for ESD and the highest for TEM (ER = 0.035). The overall bleeding rate was 0.046 and perforation rate was 0.023 and no significant differences ( P = 0.274 for bleeding, P = 0.808 for perforation) were found by intervention type. The rate of other complications (wound dehiscence, soilage, incontinence, rectovaginal fistula, pelvic pain, retroperitoneal emphysema, coagulation syndrome) was significantly ( P = 0.000) higher for TEM (ER = 0.107) than ESD (ER = 0.013). We also included 4 comparative studies with 490 patients. Using random-effects analysis, we found that the risk ratio for R0 resection was approximately 10% lower for ESD. Our analysis showed significantly greater size ( P = 0.01) and follow-up ( P = 0.03) in the group treated with TEM.
The efficacy of TEM is higher than ESD with a higher risk of complications in this method. Lesions with a greater size are treated with TEM, and recurrence rate is greater for this procedure. Long follow-up is needed after the treatment of rNETs to detect the recurrence early.
直肠神经内分泌肿瘤（rNETs）是具有恶变潜能的上皮下病变。尽管指南建议，直径10 - 20毫米的rNETs应通过内镜黏膜下剥离术（ESD）或经肛门内镜显微手术（TEM）切除，但对于这些病变的治疗仍是一个临床难题。我们进行了一项荟萃分析，以比较ESD和TEM在治疗rNETs方面的方法有效性和安全性。
检索PubMed/MEDLINE/Embase/EBSCO/CINAHL，查找分析这两种方法治疗rNETs有效性和安全性的观察性研究。
共纳入59项观察性研究，总计n = 2804名参与者。在亚组分析中，我们发现ESD的R0切除率（率：0.854）显著低于TEM（0.924）（P = 0.002）。复发率差异显著（P = 0.008）；ESD的复发率最低（事件率[ER] = 0.015），TEM的复发率最高（ER = 0.035）。总体出血率为0.046，穿孔率为0.023，按干预类型未发现显著差异（出血P = 0.274，穿孔P = 0.808）。TEM的其他并发症（伤口裂开、污染、失禁、直肠阴道瘘、盆腔疼痛、腹膜后气肿、凝血综合征）发生率（ER = 0.107）显著高于ESD（ER = 0.013）（P = 0.000）。我们还纳入了4项有490名患者的比较研究。使用随机效应分析，我们发现ESD的R0切除风险比低约10%。我们的分析显示，接受TEM治疗的组病变尺寸（P = 0.01）和随访时间（P = 0.03）显著更大。
TEM的疗效高于ESD，但该方法并发症风险更高。尺寸较大的病变采用TEM治疗，该手术的复发率更高。rNETs治疗后需要长期随访以早期发现复发。
