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Efficacy and Safety of Endoscopic Resection Therapies for Rectal Carcinoid Tumors: A Meta-Analysis

He-Sheng Luo|Tao Deng|Lei He
연세대학교의과대학 (Yonsei University College of Medicine)|2015.01|Yonsei Medical Journal|제56권 제1호|pp. 72-81|DOI 10.3349/ymj.2015.56.1.72

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meta-analysisEndoscopic submucosal dissectionendoscopic mucosal resectionrectal carcinoid tumor
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초록

Purpose: Several endoscopic resection therapies have been applied for the treatment of rectal carcinoid tumors. However, there is currently no consensus regarding the optimal strategy. We performed a meta-analysis to compare the efficacy and safety of endoscopic mucosal resection (EMR) or modified EMR (m-EMR) versus endoscopicsubmucosal dissection (ESD) for the treatment of rectal carcinoid tumors. Materials and Methods: PubMed, Web of Science, Medline, Embase and CNKI were searched up to the end of January 2014 in order to identify all studies on the effectsof EMR (or m-EMR) and ESD on rectal carcinoid tumors. Results: A total of fourteen studies involving 782 patients were included. The pooled data suggested a significantly higher rate of pathological complete resection among patients treated with ESD or m-EMR than those treated with EMR [odds ratio (OR)=0.42, 95% confidenceinterval (CI): 0.25‒0.71; OR=0.10, 95% CI: 0.03‒0.33, respectively], while there was no significant difference between the m-EMR group and ESD group (OR=1.19, 95% CI: 0.49‒2.86); The procedure time of ESD was longer than EMR or m-EMR groups [mean differences (MD)=-11.29, 95% CI: -14.19 ‒ -8.38, MD= -10.90, 95% CI: -18.69 ‒ -3.11, respectively], but it was insignificance between the EMR and m-EMR groups. No significant differences were detected among the treatmentgroups with regard to complications or recurrence. Conclusion: The results of this meta-analysis suggest that treatment of rectal carcinoid tumors with ESD or m-EMR is superior to EMR, and the efficacy of m-EMR is equivalence to ESD treatment. However, more well-designed studies are needed to confirm these findings.

Abstract

Purpose: Several endoscopic resection therapies have been applied for the treatment of rectal carcinoid tumors. However, there is currently no consensus regarding the optimal strategy. We performed a meta-analysis to compare the efficacy and safety of endoscopic mucosal resection (EMR) or modified EMR (m-EMR) versus endoscopicsubmucosal dissection (ESD) for the treatment of rectal carcinoid tumors. Materials and Methods: PubMed, Web of Science, Medline, Embase and CNKI were searched up to the end of January 2014 in order to identify all studies on the effectsof EMR (or m-EMR) and ESD on rectal carcinoid tumors. Results: A total of fourteen studies involving 782 patients were included. The pooled data suggested a significantly higher rate of pathological complete resection among patients treated with ESD or m-EMR than those treated with EMR [odds ratio (OR)=0.42, 95% confidenceinterval (CI): 0.25‒0.71; OR=0.10, 95% CI: 0.03‒0.33, respectively], while there was no significant difference between the m-EMR group and ESD group (OR=1.19, 95% CI: 0.49‒2.86); The procedure time of ESD was longer than EMR or m-EMR groups [mean differences (MD)=-11.29, 95% CI: -14.19 ‒ -8.38, MD= -10.90, 95% CI: -18.69 ‒ -3.11, respectively], but it was insignificance between the EMR and m-EMR groups. No significant differences were detected among the treatmentgroups with regard to complications or recurrence. Conclusion: The results of this meta-analysis suggest that treatment of rectal carcinoid tumors with ESD or m-EMR is superior to EMR, and the efficacy of m-EMR is equivalence to ESD treatment. However, more well-designed studies are needed to confirm these findings.

참고문헌 (35)

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