S2281 Endoscopic Submucosal Dissection Versus Trans-Anal Endoscopic Surgery for Rectal Tumors: An Updated Systematic Review and Meta-Analysis

Introduction: Colorectal cancer, particularly rectal cancer, poses significant mortality risks globally. In our systematic review and meta-analysis, we investigate the efficacy and safety of Endoscopic submucosal dissection (ESD) versus trans-anal endoscopic microsurgery (TES) for managing early-stage rectal tumors. Methods: Systematic literature retrieval was performed in PubMed, Web of Science, Scopus, and Embase from inception to April 2025. Risk of bias assessment was performed by using the Newcastle Ottawa Scale (NOS) for observational studies and Cochrane tool for assessing risk of bias in randomized trials (ROB2). Data-analysis was conducted using R version 4.2.2 (2022-10-31) and RStudio version 2022.07.2 (2009-2022, RStudio, Inc.). Results: A total of 14 studies involving 1,312 patients were analyzed, revealing comparable rates of recurrence, en bloc resection, and complication rates (bleeding and perforation) between ESD and TES. Notably, ESD demonstrated a significantly higher R0 resection rate (OR: 0.51, 95% CI: 0.30–0. 88; P = 0.0160) and shorter hospital stays compared to TES (MD: -1.22, 95% CI: -2.10– -0.35; P = 0.0063). Subgroup analyses indicated that tumor type influences outcomes, with TES showing superiority for neuroendocrine tumors. Conclusion: Despite the findings supporting current guidelines for both techniques, variations in surgical protocols and observational study designs raise concerns about biases and generalizability. Ultimately, the choice of technique should be tailored to individual tumor and patient characteristics, emphasizing the need for personalized treatment strategies. Future prospective randomized controlled trials are recommended to establish standardized protocols and long-term efficacy.