Is endoscopic submucosal dissection safe for rectal tumours extending to dentate line?

Treatment with endoscopic submucosal dissection (ESD) for rectal tumours extending to the dentate line (RTDLs) remains safe and feasible despite its poorer outcomes relative to non-RTDLs if appropriate lesions are handled by experienced operators, suggests a study.

The researchers conducted a systematic review and meta-analysis of studies reporting the clinical outcomes of ESD for RTDLs and non-RTDLs. Their primary outcomes included pooled estimated rates of en bloc/complete/curative resection, local recurrence, and incidence of bleeding, perforation, stricture, anal pain, and fever.

Six studies, including 265 cases of RTDLs and 788 cases of non-RTDLs, met the eligibility criteria. The en bloc reaction rate was similar between RTDLs and non-RTDLs (odds ratio [OR], 1.04, 95 percent confidence interval [CI], 0.55‒1.95; p=0.90). However, the complete resection rate (OR, 0.59, 95 percent CI, 0.41‒0.83; p=0.003) and the curative resection rate (OR, 0.57, 95 percent CI, 0.38‒0.87; p=0.010) were significantly lower for RTDLs.

In contrast, the rates of stricture (OR, 3.07, 95 percent CI, 1.01‒9.31; p=0.05), postoperative anal pain (OR, 42.10, 95 percent CI, 4.73‒374.97; p=0.0008), and local recurrence (OR, 3.00, 95 percent CI, 1.13‒7.96; p=0.03) were significantly higher for RTDLs than non-RTDLs.

Of note, the higher rates of postoperative bleeding (OR, 1.33, 95 percent CI, 0.53‒3.30; p=0.54) and fever (OR, 2.23, 95 percent CI, 0.55‒9.07; p=0.26), as well as the lower rate of perforation (OR, 0.85, 95 percent CI, 0.27‒2.63), for RTDLs did not reach statistical significance.

“[O]ur study showed that there were a lower complete resection rate and higher local recurrence rate in RTDL group than non-RTDL group, but ESD is still a feasible and safe treatment option for RTDLs if appropriate lesions are treated by an experienced operator, and postresection surveillance is emphasized,” the researchers said.