Systematic Review and Meta-Analysis of Published Trials Comparing the Effectiveness of Trans anal Endoscopic Microsurgery (TEMS) and Endoscopic Submucosal Dissection (ESD) in the Management of Early Rectal Cancer T1, T2

Background: Rectal cancer is one of the most important causes of mortality and morbidity in the western countries. The local excision techniques in treating early rectal cancers significantly reduce the surgical risk but it could be less effective than radical surgery. Trans anal endoscopic microsurgery (TEMS) is a minimally invasive technique that can be used for local excision of early rectal tumors. [1, 2] Endoscopic submucosal dissection (ESD) is an endoscopic alternative to surgical resection of mucosal and submucosal neoplastic lesions. [3] There is an increasing debate about the best local treatment for early rectal cancer. Aim: The aim of this study is to systematically compare the safety and effectiveness of TEMS and Endoscopic mucosal resection for early rectal cancer. Methods: Systematic Review and meta-analysis of published trials comparing the effectiveness of Trans anal Endoscopic Microsurgery TEMS and Endoscopic Submucosal Dissection ESD in the management of early rectal cancer T1, T2. Results: Two comparative trials including 87 patients were studied. There was no significant difference in R0 and En-block resection rate between the TEMS and ESD groups. OR = 1.10, 95 % CI [0.15, 8.19], z=0.10 (P=0.92). Local recurrence rate was similar in the two groups. OR = 1.82, 95 % CI [0.45, 23.25], z=0.46 (P=0.65). No significant difference in perforation rate between ESD and TEMS group. OR = 1.10, 95 % CI [0.15, 8.19], z=0.10 (P=0.92). ESD was accompanied with shorter operation time (mean difference = 46.09, 95 % CI[22.16, 70.02], Z=3.77 (P=0.0002), however the total hospital stay was similar (SMD = 1.48, 95 % CI [-4.69, 1.72], z=0.91 (P=0.36).Conclusion: Both TEMS and ESD are equally safe and good options for early rectal cancer treatment. ESD has the advantage of avoiding general anesthesia. However, large randomized controlled studies are needed to build strong evidence, as there is very small number of comparative studies and they are all retrospective obse