Local resection compared with radical resection in the treatment of T1N0M0 XXXX : a systematic review and meta-analysis.

@entity5 @entity1 @entity420 @entity260
BACKGROUND: Local resection for early @entity5 is thought to be less invasive but oncologically inferior to radical resection. OBJECTIVE: The aim of this study was to compare local with radical resection in terms of oncologic control (survival and local recurrence), @entity260 , and the need for a permanent stoma in adult @entity1 with T1N0M0 @entity420 . DATA SOURCES: Data were retrieved from Medline, Embase, Central, www.clinicaltrials.gov, and conference proceedings. STUDY SELECTION: Two reviewers independently screened studies and assessed the risk of bias. INTERVENTIONS: Local resection (transanal procedures, excluding endoscopic polypectomy) versus radical resection were considered. MAIN OUTCOME MEASURES: The primary outcomes measured were overall survival, major @entity260 , and the 'need for permanent stoma.' RESULTS: : One randomized controlled trial and 12 observational studies contributed 2855 @entity1 for analysis. The randomized controlled trial was inadequately powered. Observational study meta-analysis showed that local resection was associated with significantly lower 5-year overall survival (72 more deaths per 1000 @entity1 ; 95%CI 30-120). However, the transanal endoscopic microsurgery subgroup did not yield significantly lower overall survival than radical resection. Local resection was associated with higher local recurrence but with lower perioperative mortality (relative risk 0.31, 95% CI 0.14-0.71), major @entity260 (relative risk 0.20, 95% CI 0.10-0.41), and need for a permanent stoma (relative risk 0.17, 95% CI 0.09-0.30). Findings were robust to sensitivity analyses. Meta-regression suggests that the higher overall survival associated with radical resection may be explained by increased use of local resection on @entity5 in the lower third of the rectum, which have poorer prognosis. LIMITATIONS: This systematic review of nonrandomized studies had inherent biases that may persist despite our rigorous use of systematic review methodology and sensitivity analyses. CONCLUSIONS: Local resection does not offer oncologic control comparable to radical surgery. However, this finding may be driven by the higher prevalence of @entity5 with poorer prognosis in local resection groups. Local resection is associated with @entity260 , mortality, and the need for a permanent stoma. Local resection with transanal endoscopic microsurgery appears to offer oncologic control similar to that of radical resection while offering all the benefits of local resection.
