SRS382 - A systematic review and meta-analysis of efficacy, safety and oncological outcomes of endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD) and trans-minimally invasive surgery (TAMIS) for early rectal cancer

Abstract Introduction Minimally invasive techniques have transformed early rectal cancer treatment; yet the optimal approach is unclear. ESD, EMR, and TAMIS are increasingly being used, however, most studies only compare two of these techniques. This meta-analysis directly compares all three in efficacy, safety, and oncological performance. Methods PubMed, Scopus, and Medline were searched to identify relevant studies as of September 2024. Criteria included studies in adults with early rectal cancer treated by ESD, EMR, or TAMIS, reporting at least one outcome and specifying treatment type and cancer stage. Comprehensive Meta-Analysis v4 was used for analysis with heterogeneity assessed via I². Results A total of 127 studies encompassing 8915 patients were included (EMR = 3979, ESD = 4470, and TAMIS = 466). Mean procedural times were: overall 8.3 min (7.7–8.8), I² = 99%; EMR 7.5 (6.9–8.1), I² = 98%; ESD 32.6 (29.3–36), I² = 99%; TAMIS 101.6 (83.9–119.9), I² = 95%. En bloc resection: overall 87.1% (85.6–88.5), I² = 81%; EMR 86.5% (84.4–88.4), I² = 82%; ESD 87.2% (84.4–89.5), I² = 80%; TAMIS 94.1% (88.9–97), I² = 0%. R0 resection: overall 79.7% (78.6–80.8), I² = 80%—EMR 79.9% (78.3–81.5), I² = 85%; ESD 78.7% (77.1–80.3), I² = 76%; TAMIS 87.1% (82.8–90.4), I² = 42%. Conclusions Although EMR appears efficient, it demonstrated less favourable outcomes regarding en bloc resection. ESD showed favourable oncological outcomes while maintaining moderate procedural time. TAMIS is most time-intensive but yields the highest resection quality.