Evidence map›Paper›PMID 32860082›Full record

SynthesisInternational journal of colorectal disease2020

Endoscopic management versus transanal surgery for early primary or early locally recurrent rectal neoplasms-a systematic review and meta-analysis.

Ailish P Naughton, Éanna J Ryan, Cliodhna Tutty Bardon, Michael R Boland, Thomas M Aherne, Michael E Kelly, Maria Whelan, Paul C Neary, Deirdre McNamara, James M O'Riordan and 1 more

Abstract readMeta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in International journal of colorectal disease, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
  3. Review
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Ailish P NaughtonDepartment of Surgery, Tallaght University Hospital, Dublin, Ireland.
Éanna J RyanDepartment of Surgery, Tallaght University Hospital, Dublin, Ireland. eannaryan@rcsi.com.ORCID http://orcid.org/0000-0003-2609-0836
Cliodhna Tutty BardonDepartment of Surgery, Tallaght University Hospital, Dublin, Ireland.
Michael R BolandDepartment of Surgery, Tallaght University Hospital, Dublin, Ireland.
Thomas M AherneDepartment of Surgery, Tallaght University Hospital, Dublin, Ireland.
Michael E KellyDepartment of Surgery, Tallaght University Hospital, Dublin, Ireland.
Maria WhelanDepartment of Surgery, Tallaght University Hospital, Dublin, Ireland.
Paul C NearyDepartment of Surgery, Tallaght University Hospital, Dublin, Ireland.
Deirdre McNamaraSchool of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland.
James M O'RiordanDepartment of Surgery, Tallaght University Hospital, Dublin, Ireland.
Dara O KavanaghDepartment of Surgery, Tallaght University Hospital, Dublin, Ireland.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundBoth endoscopic techniques and transanal surgery are viable options that allow organ preservation for early rectal neoplasms. Whilst endoscopic approaches are less invasive and carry less morbidity, it is unclear whether they are as oncologically effective.

aimTo compare endoscopic techniques with transanal surgery in the management of early rectal neoplasms.

methodsA systematic literature search was performed for randomised and observational studies comparing these techniques. The pre-specified main outcomes measured were en bloc and R0 resection rates and recurrence. Pair-wise meta-analysis was performed.

resultsThis review included 1044 patients. Transanal surgery had increased R0 resection rates (odds ratio (OR) 2.66; 95% CI 1.64; 4.31; p < 0.001) versus endoscopic management. The latter was associated with higher rates of incomplete resection (OR 2.25; 95% CI 1.14, 4.46; p = 0.02) and further intervention (OR 1.78; 95% CI 1.09, 2.88; p = 0.02). There was no difference in the rates of late recurrence (OR 1.01; 95% CI 0.53, 1.91; p = 0.99) or further major surgery (OR 0.87; 95% CI 0.39, 1.94; p = 0.73) between the groups. Endoscopic treatment was associated with a shorter operating time (weighted mean difference (WMD) - 12.08; 95% CI - 18.97, - 5.19; p < 0.001) and LOS (WMD - 1.94; 95% CI - 2.43, - 1.44; p < 0.001), as well as lower rates of urinary retention post-operatively (OR 0.12; 95% CI 0.02, 0.63; p = 0.01).

conclusionEndoscopic techniques should be favoured in the setting of benign early rectal neoplasms given their decreased morbidity and increased cost-effectiveness. However, where malignancy is suspected transanal surgery should be the preferred option given the superior R0 resection rate.

Indexed as

Neoplasm Recurrence, LocalRectal NeoplasmsEndoscopyHumansOdds RatioTreatment OutcomeEndoscopic mucosal resectionEndoscopic submucosal dissectionLocal excisionSurgical outcomesTransanal endoscopic microsurgeryTransanal minimally invasive surgeryTransanal surgery

Identifiers

PMID32860082

What OpenQuestion holds

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Read underepoch 390

Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.