SYSTEMATIC REVIEW AND META-ANALYSIS OF LOCAL RESECTION OR TRANSANAL ENDOSCOPIC MICROSURGY VERSUS RADICAL RESECTION IN STAGE I RECTAL CANCER: A REAL STANDARD?

• Published in: Critical reviews in oncology/hematology
• Main Authors: Veereman, Geneviève, Vlayen, Joan, Robays, Jo, Fairon, Nicolas, Sabine, Stordeur, Rolfo, Christian, Bielen, Didier, Bols, Alain, Demetter, Pieter, D’hoore, André, Haustermans, Karin, Hendlisz, Alain, Lemmers, Arnaud, Leonard, Daniel, Penninckx, Freddy, Van Cutsem, Eric, Peeters, Marc
• Format: Journal Article
• Language: English
• Published: 2017
• Subjects: Hematology, Oncology and Palliative Medicine; PICO; Preferred Reporting Items for Systematic Reviews and Meta-analysis; Transanal excision; LR; ITT; Systematic review; DFS; Risk ratio; MA; Stage I; TEM(S); ESGE; Quality of life; AR; Endoscopic submucosal dissection; Randomised controlled trial; Transanal endoscopic microsurgery; Rectum; Overall survival; European Society of Gastrointestinal Endoscopy; RR; RCT; NCCN; MRI; Local recurrence; Population-Intervention-Comparator-Outcome; QoL; National Institute for Health and Care Excellence; ESD; Total mesorectal excision; Disease free survival; Local recurrence free survival; SR; OR; OS; Belgian Health Care Knowledge Centre; CI; PRISMA; KCE; TME; resection; Confidence interval; Intention-to-treat; Meta-analysis; LRFS; Magnetic resonance imaging; NICE; Odds ratio; TAE; National Comprehensive Cancer Network; cancer; Abdominal resection; surgery
• ISSN: 1040-8428
• DOI: 10.1016/j.critrevonc.2017.03.008

Abstract Current guidelines recommend radical resection for stage I rectal cancer. However, since screening programs are being installed, an increasing number of cancers are being detected in early stages. Endoscopic resection is often performed at the time of diagnosis. This systematic review was undertaken to review the evidence on endoscopic approach vs. radical resection for stage I rectal cancer. Recommendations were issued based on the GRADE methodology and risk stratification used in clinical practice. A systematic search (until March 2015) identified 2 meta-analyses and 1 additional randomized trial. For the primary outcomes (overall survival, disease-free survival, local recurrence-free survival and metastasis-free survival) no evidence could be found on the superiority of local or radical resection. Secondary outcomes (blood loss, hospital stay, operative time, number of permanent stomas and perioperative deaths) were in favour of local resection. The authors strongly recommend radical resection for T2 rectal cancer, but consider ‘en bloc’ local resection sufficient for pT1 sm1 rectal cancers when confirmed pathologically. Discussion by a multidisciplinary team and adequate surveillance remain mandatory.