Comparison between Endoscopic Submucosal Dissection and Transanal Endoscopic Microsurgery in Early Rectal Neuroendocrine Tumor Patients: A Meta-Analysis

Figures & data

FIGURE 1. Flowchart of studies inclusion.

TABLE 1. Methodology validation for eligible studies

Author	Choice of patients				Comparability	Results			Stars
	Representativeness of ESD group	Representativeness of TEM group	Procedure records was objective	All patients were suffered from RNET		Results were objective	Follow-up timewas 2 year or longer	Two year follow-up rate was 60% or higher
Park SS et al.^10	★	★	★	★	★	★	★	★	8
Jin R et al.^15	★	★	★	★	★	★			6
Jeon JH et al.^20	★	★	★	★	★	★	★	★	8

ESD: endoscopic submucosal dissection; TEM: transanal endoscopic microsurgery; RNET: rectal neuroendocrine tumor

Studies were evaluated as high quality if 5 or more stars were obtained, otherwise studies were evaluated as low quality.

FIGURE 2. a) Comparison of age between ESD group and TEM group. b) Comparison of male rate between ESD group and TEM group. c) Comparison of tumor level between ESD group and TEM group. d) Comparison of tumor size between ESD group and TEM group.

TABLE 2. Baseline characteristics of included RNET patients

Author	Year	Country	Study style	Group	Sample size	Age	Male (rate)	Tumor level (cm)	Histologic tumor size (mm)	Grade of WHO G1 (rate)/G2 (rate)/G3 (rate)
Park SS et al.^10	2021	Korea	Retrospective	ESD	226	48.9 ± 10.4	155 (68.6)	6 (2–17)	5 (0.8–15)	NM
				TEM	59	50.9 ± 11.6	41 (69.5)	6 (3–13)	6 (2–21)	NM
Jin R et al.^15	2022	China	Retrospective	ESD	55	52.9 ± 11.7	20 (36.4)	8 (3–15)	7 (2–20)	47 (85.5)/8 (14.5)/0 (0)
				TEM	59	51.1 ± 12.1	18 (30.5)	7 (3–10)	6 (2–20)	45 (76.3)/13 (22)/1 (1.7)
Jeon JH et al.^20	2014	Korea	Retrospective	ESD	23	51 ± 12.3	15 (65.2)	6.6 ± 2.8	6.7 ± 1.8	NM
				TEM	14	48.5 ± 14.4	9 (64.3)	6.7 ± 2.8	8.2 ± 3	NM

ESD: endoscopic submucosal dissection; TEM: transanal endoscopic microsurgery; NM: not mentioned; Tumor level: the distance between tumorous lower margin and anal verge; Histologic tumor size: the tumor size based on histopathology; G1: Ki-67 ≤ 2% and/or mitotic count < 2 per 2 mm²; G2: Ki-67 3–20% and/or mitotic count 2–20 per 2 mm²; G3: Ki-67 > 20% and/or mitotic count > 20 per 2 mm².

FIGURE 3. a) Comparison of R0 resection rate between ESD group and TEM group. b) Comparison of recurrence rate between ESD group and TEM group.

TABLE 3. Effectiveness, safety and cost-effectiveness of included studies

Author	Group	R0 resection (rate)	Procedure time (min)	Adverse events (rate)	Hospital stay (day)	Recurrence (rate)	Additional treatment (rate)
Park SS et al.^10	ESD	185 (81.9)	25 (7–86)	2 (0.9)	3 (0–5)	2 (0.9)	22 (9.7)
	TEM	54 (91.5)	35 (17–180)	4 (6.8)	4 (3–8)	0	5 (8.5)
Jin R et al.^15	ESD	39 (70.9)	N = 14, 27.5 (10–60)	4 (7.3)	4 (2–26)	1 (1.8)	6 (10.9)
	TEM	54 (91.5)	n = 49, 57 (20–180)	3 (5.1)	4 (1–9)	4 (6.8)	2 (3.4)
Jeon JH et al.^20	ESD	19 (82.6)	18 ± 13.2	11 (47.8)	3.8 ± 0.8	0	1 (4.3)
	TEM	14 (100)	40.7 ± 14.2	0	5.3 ± 1.1	0	0

ESD: endoscopic submucosal dissection; TEM: transanal endoscopic microsurgery

Adverse events: perforation, bleeding, wound disruption and voiding difficulty.

FIGURE 4. a) Comparison of adverse events rate between ESD group and TEM group. b) Comparison of additional treatment rate between ESD group and TEM group.

FIGURE 5. a) Comparison of procedure time between ESD group and TEM group. b) Comparison of hospital stay between ESD group and TEM group.

DATA AVAILABILITY

All data available upon request.