Endoscopic Submucosal Dissection (ESD) Offers a Safer and More Cost-effective Alternative to Transanal Endoscopic...

Area of Science:

• Gastroenterology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Early rectal cancer (ERC) is treated with endoscopic submucosal dissection (ESD) and transanal endoscopic microsurgery (TEM).
• Limited comparative studies exist between ESD and TEM for ERC.
• This study aimed to identify optimal patient candidates for each procedure.

Purpose of the Study:

• To compare the efficacy and safety of endoscopic submucosal dissection (ESD) versus transanal endoscopic microsurgery (TEM) for early rectal cancer (ERC).
• To determine ideal patient selection criteria for ESD and TEM in ERC treatment.

Main Methods:

• A comparative analysis of 204 ERC patients treated with ESD (n=101) or TEM (n=103) between January 2016 and November 2019 across 7 international centers.
• Data collected included clinical success, tumor characteristics, procedural details, and recurrence rates.

Main Results:

• Tumor size was significantly larger in the TEM group (56 mm) compared to the ESD group (40 mm) (P <0.00001).
• ESD procedures had longer average operative times (131.5 min) than TEM (104.9 min) (P =0.000347).
• ESD resulted in shorter hospital stays (3.3 days) versus TEM (4.7 days) (P <0.00001) with a lower adverse event rate (6.8% vs 24%).
• No significant differences were observed in en bloc resection, technical success, tumor location, need for additional procedures, or recurrence rates between the two groups.

Conclusions:

• Endoscopic submucosal dissection (ESD) is a safer treatment option for early rectal cancer (ERC) compared to transanal endoscopic microsurgery (TEM).
• ESD offers a shorter hospital stay and is recommended for patients with ERC.
• Further research may refine patient selection for optimal outcomes with ESD and TEM.