Comparison of transanal endoscopic microsurgery with or without neoadjuvant therapy and standard total mesorectal excision in the treatment of clinical T2 low rectal cancer: a meta-analysis
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Zheng-Shui Xu1,#, Hua Cheng2,#, Yuhong Xiao3,#, Jia-Qing Cao2, Fei Cheng2, Wen-Ji Xu2, Jia-Qi Ying2, Jun Luo4,* and Wei Xu2,*
1Department of General Surgery, Xi’an N0.4 Hospital, 710000 Xi’an, Shanxi, China
2Department of General Surgery, The Second Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
3The Second Clinical Medical College, Nanchang University, 330006 Nanchang, Jiangxi, China
4Department of Rehabilitation Medicine, The Second Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
#These authors contributed equally to this study and share first authorship
*These authors contributed equally to this study and share corresponding authorship
Wei Xu, email: [email protected]
Jun Luo, email: [email protected]
Keywords: rectal cancer, transanal endoscopic microsurgery, neoadjuvant therapy, total mesorectal excision, meta-analysis
Received: December 10, 2016 Accepted: September 18, 2017 Published: October 26, 2017
Some clinical trials demonstrated local resection for clinical T1 rectal cancer was safe and effective. But for clinical T2 rectal cancer, the results were controversial. Neoadjuvant therapy (NT) is proven to reduce the opportunity of advanced rectal cancer recurrence in various researches. The objective of this Meta-Analysis was to evaluate the oncological outcomes of transanal endoscopic microsurgery (TEM) with or without NT comparing with conventional total mesorectal excision (TME) for the treatment of clinical T2 rectal cancer.To search for the relevant studies, an electronic search was done from the databases of Pubmed, Embase, and the Cochrane Library in this meta-analysis. We compared the effectiveness of transanal endoscopic microsurgery with or without NT and standard total mesorectal excision in the treatment of T2 Rectal Cancer. 1RCT and 3nRCTs including 121 TEM patients (TEM + NT: 59, TEM: 62) and 174 TME patients with T2 rectal cancer were retrieved. Compared with TME, there were no significant differences in the outcomes of local recurrence, overall recurrence, overall survival between TEM + NT group. However in compassion with TME, TEM without NT was associated with an increased local recurrence, overall recurrence, and a shorter overall survival, with individual ORs being 3.04 (95% Cl: 1.17–7.90; I2 = 0%), 5.67 (95% Cl: 1.58–20.38; I2 = 0%) and 0.12 (95% Cl: 0.02–0.65; I2 = 0%), respectively. Compared with TME, TEM after NT may be a feasible and safe organ preservative approach for patients with clinical T2 low rectal cancer. But for those without NT, TEM always seem be associated with worse oncological outcomes.
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