Comparative efficacy and safety of endoscopic submucosal dissection versus transanal endoscopic microsurgery for the treatment of rectal polyps: a systematic review and meta-analysis

Rectal cancer represents approximately 35% of colorectal cancer cases in the European Union. Early-stage tumors may be treated with less invasive techniques, such as endoscopic submucosal dissection (ESD) and transanal endoscopic microsurgery (TEM). This systematic review and meta-analysis evaluates the comparative efficacy and safety of ESD versus TEM for early-stage rectal cancer. A literature search was conducted in PubMed, Scopus, Embase, and Cochrane databases up to October 2024. Studies comparing ESD and TEM outcomes in adult patients with rectal tumors were included. Outcomes assessed included the rates of en-bloc resection, recurrence, overall complications, R0 resection rates, postoperative bleeding, reoperation rates, perforation rates, operative time, and length of hospital stay. Statistical analyses were performed using both fixed and random effects models. Seven retrospective studies involving 671 patients were included. Pooled analyses showed that ESD achieved higher en-bloc resection rates [odds ratio (OR) = 0.29, 95% confidence interval (CI): 0.10–0.83, P = 0.02), lower tumor recurrence rates (OR = 0.29, 95% CI: 0.12–0.70, P = 0.006) and lower overall complication rate (OR = 0.50, 95% CI: 0.31–0.81, P = 0.005). No significant differences were observed in terms of R0 resection rates, operative time, postoperative bleeding, and reoperation rates. ESD achieves favorable outcomes over TEM for early-stage rectal cancer by achieving higher en-bloc resection rates, lower rates of recurrence, and complications. Despite ESD’s technical complexity, its superior precision and lower complication profile make it a promising option for early-stage rectal cancer, though clinician expertise and available resources should guide treatment selection.