Authors' objectives: To compare the benefits and complications of TEM with radical surgery and other local resection procedures in patients with early-stage rectal adenoma and cancer.

Authors' results and conclusions: Two of the original 3 papers with a control group were retrieved from the previous systematic review which was considered to be of good quality. These included one clinical trial and a cohort study, both of poor quality. Four papers were selected from among the 74 articles found in the new search which met the inclusion criteria. These are namely: one medium quality, controlled clinical trial and three cohort studies with limitations in internal validity. With the data provided by the new papers on the comparison of TEM versus local surgical techniques (3 studies), the only endpoints considered in most of the studies and that show a certain degree of consistency in outcomes are post-operative complications and incomplete tumour resection. Both of these events are less frequently reported in TEM patients. As for the comparison between TEM and radical surgical techniques, three new studies were found that were added to the two papers selected in the previous review. The information from these 5 studies overall show that most endpoints have better outcomes in TEM patients, both as regards technical endpoints and survival and also reveal discrepancies in recurrence rates between studies. All these results should be interpreted with caution, however, as the studies present major flaws in internal validity. In particular, 87% of patients undergoing radical surgery had rectal cancers, compared with only 50% in the TEM patients; besides the fact that no adjustment for possible confounding factors was made in the comparative analysis of the groups. Assessment of functional outcomes with the different techniques was only vaguely addressed.

Authors' recommendations: The quality and nature of available evidence on the efficacy of TEM compared with other surgical options do not currently enable recommendations to be issued for more widespread use of the technique.

Authors' methods: Review

Project Status: Completed

URL for project: https://www.aetsa.org/publicacion/efectividad-de-la-cirugia-endoscopica-transanal-en-tumores-rectales/

Year Published: 2008

URL for published report: https://www.aetsa.org/download/publicaciones/antiguas/AETSA_2006-19_CirugTransanal.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Andalusian Health Technology Assessment Area

Contact Address: Area de Evaluacion de Tecnologias Sanitarias Sanitarias de Andalucia (AETSA) Avda. Innovación, s/n Edificio Arena 1. Sevilla (Spain) Tel. +34 955 006 309

Contact Name: aetsa.csalud@juntadeandalucia.es

Contact Email: aetsa.csalud@juntadeandalucia.es

Copyright: Andalusian Agency for Health Technology Assessment (AETSA)