Trans-anal Endoscopic Surgery vs. Conventional Transanal Surgery


P (patients)

I (intervention)

C (comparator)

O (outcomes)

Patients undergoing transanal endoscopic surgery (TES)

TES

Patients undergoing conventional transanal excision, posterior approach, or endoscopic submucosal or mucosal resection (alternative methods)

Negative margins, tumor fragmentation, recurrence rates, perioperative outcomes




Results


Table 45.2 summarizes the literature. The table is organized to reflect those factors for which TEM/TES (collectively referred to as TES) has advantages to, is equal to, or is disadvantageous compared to the alternative techniques. Overall there is a paucity of manuscripts comparing these techniques with the other methods of local excision. As stated above, a randomized prospective study is not likely to appear because once the technique is mastered, some form of TES will become the preferred approach for surgeons. There is only one prospective, randomized study and excision of only adenomas is considered. [2] Of the remaining studies, there are 3 meta-analyses, [35] one systematic review, [6] and several retrospective series [714] where the control groups are within the same institution, other institutions, or literature based. Study designs are generally flawed.


Table 45.2
Analyzed studies




































































































Author (year)

Study type

Level of evidence

Patients

Results

TES > alternativea

TES=alternative

Alternative > TESb

Clancy (2015) [4]

Systematic review
 
492 TES, 435 conventional transanal excision

Negative margins

Less tissue fragmentation

Recurrence rate

Complication rate
 

Moore (2008) [9]

Retrospective
 
82 TES, 89 conventional

Negative margins

Less fragmentation

Recurrence rate

Complications
 

Winde (1996) [2]

Prospective randomized
 
90 TEX, 98 conventional; adenomas only

Local recurrence
   

Sgourakis (2011) [3]

Meta-analysis
 
TES vs conventional for T1 and T2 cancers

Negative margins

Disease free survival
   

Han (2012) [8]

Case controlled
 
53 TES, 76 conventional

Local recurrence

Distance from anus
 
Operative time

de Graaf (2010) [7]

Case controlled
 
216 TES, 43 conventional; all adenomas

Operative time complications

Negative margins

Less fragmentation

Local recurrence
   

Lebedyev (2009) [10]

Retrospective
 
24 TES, 18 conventional; all T1 cancer
 
Negative margins complications recurrence
 

Christoforidis (2009) [1]

Retrospective
 
42 TES, 129 conventional; postoperative adjuvant therapy

Negative margins fragmentation

Disease free survival for tumors ≥ 5 cm
 

Langer (2003) [11]

Retrospective
 
79 TES, 76 conventional; T1 and T2 cancers and adenomas

Local recurrence

2 year survival
 

Nakagoe (2003) [12]

Case controlled
 
45 TES, 26 posterior approach; adenomas and cancer

Operative time, blood loss, length of stay analgesic need complications

Only gold members can continue reading. Log In or Register to continue

Jul 13, 2018 | Posted by in ABDOMINAL MEDICINE | Comments Off on Trans-anal Endoscopic Surgery vs. Conventional Transanal Surgery
Premium Wordpress Themes by UFO Themes