Does transanal endomicrosurgery affects the results of “salvage mesorectumectomy” for patients with early rectal cancer? Systematic review and meta-analysis

Abstract

Aim. Our systematic review and meta-analysis aimed to compare studies with primary mesorectumectomy (pME) and “salvage mesorectumectomy” (sME) after transanal endomicrosurgery for patients with early rectal cancer.Materials and methods. We selected publications from 1 January 1999 to 1 April 2023. A total of 7 studies were included after screening. Following indicators were compared: quality of mesorectum, frequency of abdominoperineal resection, frequency of local recurrence and distant metastases, mortality, morbidity, time of surgery, post-operative stay, frequency of involvement of circular resection margin. Statistical data was processed using ReviewManager 5.3.Results. Statistically significant differences were observed in probability of intraoperative damaging of mesorectal fascia (Odds Ratio (OR) 0.42; 95 % Confidence Interval (CI) 0.24–0.72, р = 0.002). There were also a trend towards decreasing of number of sphincter-preserving operations after transanal endomicrosurgery (TEM) (OR 1.84; 95 % CI 0.96–3.52, р = 0,06). Other indicators didn’t reach statistical significance when compared.Conclusion. sTME is a safe procedure and comparable with pME. However, previous TEM is considered a risk factor for damaging of mesorectum, intraoperative perforation and abdominoperineal resection.