Endoscopic submucosal dissection versus transanal endoscopic  microsurgery for the treatment of early rectal cancer.
BACKGROUND
Endoscopic submucosal dissection (ESD) and transanal endoscopic microsurgery (TEM) are minimally invasive procedures that can be used to treat early rectal cancer.


OBJECTIVE
The aim of this study was to compare clinical efficacy between ESD and TEM for the treatment of early rectal cancer.


METHODS
Between July 2008 and August 2011, 24 patients with early rectal cancers were treated by ESD (11) or TEM (13) at the Cancer Institute of São Paulo University Medical School (São Paulo, Brazil). Data were analyzed retrospectively according to database and pathological reports, with respect to en bloc resection rate, local recurrence, complications, histological diagnosis, procedure time and length of hospital stay.


RESULTS
En bloc resection rates with free margins were achieved in 81.8 % of patients in the ESD group and 84.6 % of patients in the TEM group (p = 0.40). Mean tumor size was 64.6 ± 57.9 mm in the ESD group and 43.9 ± 30.7 mm in the TEM group (p = 0.13). Two patients in the TEM group and one patient in the ESD group had a local recurrence. The mean procedure time was 133 ± 94.8 min in the ESD group and 150 ± 66.3 min in the TEM group (p = 0.69). Mean hospital stay was 3.8 ± 3.3 days in the ESD group and 4.08 ± 1.7 days in the TEM group (p = 0.81).


CONCLUSIONS
This was a non-randomized clinical trial with a small sample size and selection bias in treatment options.


CONCLUSIONS
ESD and TEM are both safe and effective for the treatment of early rectal cancer.
Fábio Shiguehissa
FS
Kawaguti
Caio Sérgio Rizkallah
CS
Nahas
Carlos Frederico Sparapan
CF
Marques
Bruno da Costa
BC
Martins
Felipe Alves
FA
Retes
Raphael Salles S
RS
Medeiros
Takemasa
T
Hayashi
Yoshiki
Y
Wada
Marcelo Simas
MS
de Lima
Ricardo Sato
RS
Uemura
Sérgio Carlos
SC
Nahas
Shin-ei
SE
Kudo
Fauze
F
Maluf-Filho
D001003:Anal Canal; D004210:Dissection / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D009367:Neoplasm Staging; D011351:Proctoscopy / Q000379:methods*; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome