Original Title: Actualización: Cirugía transanal endoscópica rígida (TEM/ TEO) o flexible (TAMIS) para el tratamiento de lesiones de recto

Authors' recommendations: "Low-quality evidence suggests that endoscopic transanal surgery performed on both rigid (transanal endoscopic microsurgery or endoscopic transanal surgery) and flexible (minimally invasive transanal surgery) platforms in patients with benign, premalignant lesions or very low risk rectal tumors (T1N0) may yield a greater net benefit by presenting a lower recurrence rate, higher rate of total free resection margins (R0) and less fragmentation of the specimen, versus conventional transanal surgery. Low-quality evidence suggests that when compared to endoscopic submucosal resection, these techniques show a similar benefit, since no differences in R0 resection, recurrence and complication rates were evidenced. It worth considering that both the availability and the learning curve of endoscopic submucosal resection make its implementation difficult. Low-quality evidence suggests that endoscopic transanal surgery, performed using both platforms, in patients with very low-risk rectal tumors (T1N0) may yield a greater net benefit versus total mesorectal excision because it has lower mortality and perioperative complications, as well as less ostomy requirements and hospital stay. Although the local recurrence rate is higher with endoscopic transanal surgery, patients are eligible for a subsequent procedure. Most of the clinical practice guidelines developed for this technology recommend that transanal endoscopic surgery should be performed by experts in patients with very low-risk rectal tumors with favorable clinical and pathologic features, with subsequent restaging according to pathological findings. In Latin America, only Brazil covers local excision of low-grade rectal tumors in selected cases, without clarifying surgical techniques. Australia provides 75% coverage for resection of rectal tumors by endoscopic transanal surgery. The United States Center for Medicare and Medicaid Services provides coverage for transanal endoscopic surgery and a private funder in the United States provides coverage for transanal endoscopic microsurgery. In Argentina, this technology is not included in the Mandatory Medical Program. An economic evaluation from Spain concludes that transanal endoscopic microsurgery is cost-effective. Although the cost of these technologies does not differ substantially from that of their comparators, since no local evidence is available, no conclusions can be drawn about their cost-effectiveness."

Project Status: Completed

Year Published: 2024

URL for published report: https://ets.iecs.org.ar/publication/2255

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Argentina

Organisation Name: Institute for Clinical Effectiveness and Health Policy

Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA

Contact Name: info@iecs.org.ar

Contact Email: info@iecs.org.ar

Copyright: <p>Institute for Clinical Effectiveness and Health Policy (IECS)</p>