SP 3.09 Endoscopic Submucosal Dissection (ESD) versus Transanal Endoscopic Microsurgery (TEM) and Transanal Minimally Invasive Surgery (TAMIS) for Early-Stage Rectal Cancer: Meta-Analysis
George Bisheet, Elia Azir, Charles BaileyAbstract
Background
Minimally invasive techniques such as endoscopic submucosal dissection (ESD), transanal endoscopic microsurgery (TEM), and transanal minimally invasive surgery (TAMIS) are increasingly used as alternatives to radical surgery for early rectal cancer. These approaches aim to achieve complete local excision with reduced morbidity and comparable oncologic outcomes; however, their relative effectiveness remains debated.
Objective
To compare ESD, TEM, and TAMIS for early-stage rectal cancer with respect to complete excision (R0 resection), local recurrence, operative complications, procedure time, and postoperative hospital stay.
Methods
A systematic search of PubMed, Embase, and the Cochrane Library was performed. Comparative studies evaluating ESD versus TEM or TAMIS for rectal neoplasms were included. Outcomes were pooled using a random-effects model. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed using the I² statistic.
Results
Ten retrospective comparative studies published between 2013 and 2025 were included. No significant difference in R0 resection rates was observed between ESD and TEM/TAMIS (OR 0.46, 95% CI 0.20–1.06, p=0.067; I²=54%). Local recurrence rates were similarly low (OR 0.65, 95% CI 0.26–1.58, p=0.34; I²=0%), with comparable en-bloc resection and complication rates. ESD was associated with a significantly shorter postoperative hospital stay (MD –1.92 days, 95% CI –2.87 to –0.97, p<0.001), although heterogeneity was substantial. Narrative analysis suggested shorter procedure times for ESD.
Conclusions
ESD demonstrates oncologic outcomes comparable to TEM/TAMIS.