title: TEM and conventional rectal surgery for T1 rectal cancer: a meta-analysis.
abstract: OBJECTIVE
  To compare transanal endoscopic microsurgery (TEM) with conventional radical surgery (CRS) for T1 rectal cancer focusing on safety, feasibility and efficacy of both procedures.
  
  
  METHODS
  An online search of Ovid, Medline, Embase, Pubmed and Cochrane Controlled Trials Register was undertaken to identify studies comparing TEM with CRS published in English between 1984 and March 2010. Only studies comparing TEM with CRS for T1 rectal cancer treatment and with a minimum of 20 cases were included. The parameters compared were postoperative complications, hospital mortality, recurrence rate and 5-year survival.
  
  
  RESULTS
  Five studies met screening criteria and 397 patients were enrolled in the meta-analysis; 216 were treated with TEM and the rest received CRS. Complications were observed in 16/196 in the TEM group and 77/163 in the CRS group. The difference was significant (p=0.01). The rate of mortality was 3.68% in CRS group, and 0 in TEM group (p=0.01). The 5-year survival was similar (p=0.84), the TEM group was 80.1% and the CRS group was 81.0%. However, there was more recurrence in the TEM group compared to CRS group (p=0.0004). TEM group was 12.0%, while CRS group was 0.5%.
  
  
  CONCLUSIONS
  Compared with CRS, TEM had significant shorter hospital stay and fewer postoperative complications. TEM is a safe, feasible and effective option for T1 rectal cancer. Though TEM had a slightly higher rate of recurrence than CRS, no significant difference on 5-year survival was observed.
authors.affiliation: Department of General Surgery, The Second Affiliated Hospital, Soochow University, Suzhou, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Wu
authors.forename: Yong-You
authors.initials: YY
authors.lastname: Wu
authors.forename: Shan
authors.initials: S
authors.lastname: Li
authors.forename: Bao-Song
authors.initials: BS
authors.lastname: Zhu
authors.forename: Kui
authors.initials: K
authors.lastname: Zhao
authors.forename: Xiao-Dong
authors.initials: XD
authors.lastname: Yang
authors.forename: Chun Gen
authors.initials: CG
authors.lastname: Xing
mesh_terms: D016099:Endoscopy, Gastrointestinal; D017052:Hospital Mortality; D006801:Humans; D008866:Microsurgery / Q000379:methods*; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000209:etiology; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000601:surgery*