title: Comparing endoscopic submucosal dissection with transanal resection for non-invasive rectal tumor: a retrospective study.
abstract: OBJECTIVE
  Endoscopic submucosal dissection (ESD) is an alternative to transanal resection (TAR) in treating rectal adenomas, intramucosal cancers, and superficial submucosal cancers. The purpose of this study is to compare the clinical efficacy between ESD and TAR for non-invasive rectal tumors.
  
  
  METHODS
  Between January 1998 and December 2006, 85 patients with preoperative diagnosis of non-invasive rectal tumors were treated by ESD or TAR. En-bloc resection, local recurrence, complication, procedure time, and hospital stay were evaluated retrospectively using a prospectively-completed database.
  
  
  RESULTS
  Mean resection sizes were 40 mm and 39 mm in diameter for the ESD and TAR groups, respectively. En-bloc resections with a negative resection margin were achieved in 67% (35/52) of the ESD group, which was significantly higher than the 42% (14/33) in the TAR group. Sixty-three lesions were diagnosed as curative resection, histopathologically. There was no local recurrence in the ESD group, but five local recurrences developed in the TAR group. Two rectal perforations, one minor delayed bleeding, and one subcutaneous emphysema in the ESD group were successfully managed conservatively. There were one minor delayed bleeding and two anesthesia-related complications in the TAR group. The ESD group had a shorter hospital stay than the TAR group (4.9 days vs 7 days), but a longer procedure time (131 min vs 63 min).
  
  
  CONCLUSIONS
  ESD was more effective than TAR in treating non-invasive rectal tumors, with a lower recurrence rate and shorter hospital stay.
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Kiriyama
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Saito
authors.forename: Takahisa
authors.initials: T
authors.lastname: Matsuda
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakajima
authors.forename: Yumi
authors.initials: Y
authors.lastname: Mashimo
authors.forename: Henry K M
authors.initials: HK
authors.lastname: Joeng
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Moriya
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kuwano
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery; D007564:Japan; D007902:Length of Stay; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000209:etiology; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome