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International Journal of Colorectal Disease

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01-07-2020 | Review

Comparison of the transanal surgical techniques for local excision of rectal tumors: a network meta-analysis

Authors: Konstantinos Perivoliotis, Ioannis Baloyiannis, Chamaidi Sarakatsianou, George Tzovaras

Published in: International Journal of Colorectal Disease | Issue 7/2020

Abstract

Background

In order to assess the various surgical modalities for local resection of rectal tumors, a systematic review of the current literature and a network meta-analysis (NMA) was designed and conducted.

Methods

The present study adhered to the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions principles. Scholar databases (Medline, Scopus, Web of Science) were systematically screened up to 23/12/2019. A Bayesian NMA, implementing a Markov chain Monte Carlo analysis, was introduced for the probability ranking of the available surgical methods. Odds ratio (OR) and weighted mean difference (WMD) of the categorical and continuous variables, respectively, were reported with the corresponding 95% confidence interval (95%CI).

Results

Overall, 16 studies and 2146 patients were introduced in our study. Transanal minimal invasive surgery (TAMIS) displayed the highest performance regarding the overall postoperative morbidity, the perioperative blood loss, the length of hospitalization, and the peritoneal violation rate. Transanal endoscopic microsurgery (TEM) was the most efficient modality for resecting an intact specimen. Although transanal local excision (TAE) had the highest ranking considering operative duration, it was associated with a significant risk for positive resection margins and tumor recurrence.

Conclusions

In conclusion, TEM and TAMIS display superior oncological results over TAE. Due to several limitations, validation of these results requires further RCTs of a higher methodological level.

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Title: Comparison of the transanal surgical techniques for local excision of rectal tumors: a network meta-analysis
Authors: Konstantinos Perivoliotis
Ioannis Baloyiannis
Chamaidi Sarakatsianou
George Tzovaras
Publication date: 01-07-2020
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 7/2020
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-020-03634-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Comparison of the transanal surgical techniques for local excision of rectal tumors: a network meta-analysis

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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