Trans-anal Endoscopic Surgery vs. Conventional Transanal Surgery

P (patients)

I (intervention)

C (comparator)

O (outcomes)

Patients undergoing transanal endoscopic surgery (TES)


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

Negative margins, tumor fragmentation, recurrence rates, perioperative outcomes


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



TES > alternativea


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]

82 TES, 89 conventional

Negative margins

Less fragmentation

Recurrence rate


Winde (1996) [2]

Prospective randomized
90 TEX, 98 conventional; adenomas only

Local recurrence

Sgourakis (2011) [3]

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]

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

Christoforidis (2009) [1]

42 TES, 129 conventional; postoperative adjuvant therapy

Negative margins fragmentation

Disease free survival for tumors ≥ 5 cm

Langer (2003) [11]

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

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