Systematic review and meta-analysis of local resection or transanal endoscopic microsurgery versus radical resection in stage i rectal cancer: A real standard?
| Autor: | Alain Hendlisz, Alain Bols, Daniel Leonard, Jo Robays, Marcus Peeters, André D'Hoore, Pieter Demetter, Nicolas Fairon, Christian Rolfo, Freddy Penninckx, Joan Vlayen, Geneviève Veereman, Sabine Stordeur, Didier Bielen, Arnaud Lemmers, Karin Haustermans, Eric Van Cutsem |
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| Přispěvatelé: | Clinical sciences, Growth and Development |
| Rok vydání: | 2017 |
| Předmět: |
Transanal Endoscopic Microsurgery
medicine.medical_specialty Colorectal cancer Rectum Review law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Journal Article Humans Medicine Neoplasm Staging Transanal Excision Rectal Neoplasms business.industry Cancer Hematology Perioperative medicine.disease Total mesorectal excision Surgery meta-analysis Treatment Outcome medicine.anatomical_structure Oncology 030220 oncology & carcinogenesis Meta-analysis 030211 gastroenterology & hepatology Human medicine Neoplasm Recurrence Local business |
| Zdroj: | Critical reviews in oncology, hematology |
| ISSN: | 1040-8428 |
| Popis: | Current guidelines recommend radical resection for stage I rectal cancer. However, since screening programs are being installed, an increasing number of cancers are being detected in early stages. Endoscopic resection is often performed at the time of diagnosis. This systematic review was undertaken to review the evidence on endoscopic approach vs. radical resection for stage I rectal cancer. Recommendations were issued based on the GRADE methodology and risk stratification used in clinical practice. A systematic search (until March 2015) identified 2 meta analyses and 1 additional randomized trial. For the primary outcomes (overall survival, disease-free survival, local recurrence-free survival and metastasis-free survival) no evidence could be found on the superiority of local or radical resection. Secondary outcomes (blood loss, hospital stay, operative time, number of permanent stomas and perioperative deaths) were in favour of local resection. The authors strongly recommend radical resection for T2 rectal cancer, but consider 'en bloc' local resection sufficient for pT1 sm1 rectal cancers when confirmed pathologically. Discussion by a multidisciplinary team and adequate surveillance remain mandatory. (C) 2017 Elsevier B.V. All rights reserved. |
| Databáze: | OpenAIRE |
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