Intestinal Research

Review

Tumor

Comparison between endoscopic resection and transanal surgery for treatment of rectal tumors: a systematic review and meta‑analysis: Chan Hyuk Park, Byung Wook Jung, Yoon Suk Jung; Intest Res 2026;24(1):38-51. Published online December 5, 2025; DOI: https://doi.org/10.5217/ir.2025.00180

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Both endoscopic resection (ER) and transanal surgery (TAS) are minimally invasive treatment options that allow organ preservation in early rectal tumors. We conducted a meta-analysis to compare treatment outcomes between the 2 treatments.
Methods
We searched all relevant studies published until January 2024 that examined the comparative outcomes between ER and TAS for rectal tumors, including adenoma, adenocarcinoma, and neuroendocrine tumor (NET). TAS included transanal excision, transanal endoscopic microsurgery, and transanal minimally invasive surgery.
Results
Seventeen studies with a total of 1,569 patients were included in this meta-analysis. For adenoma/adenocarcinoma, the R0 resection rate did not differ between ER and TAS (risk ratio [RR], 0.99; 95% confidence interval [CI], 0.94–1.03). For NET, the R0 resection rate was lower in the ER group than in the TAS group (RR, 0.76; 95% CI, 0.68–0.84) and the procedure time for ER was shorter than that for TAS. For both adenoma/adenocarcinoma and NET, ER and TAS did not differ in terms of complication rates, additional surgery, and recurrence.
Conclusions
ER and TAS showed similar treatment outcomes for adenoma/adenocarcinoma. Considering that TAS typically incurs higher costs than ER, ER may be favored in the treatment of rectal adenoma/adenocarcinoma. For rectal NET, TAS showed a superior R0 resection rate than ER. However, given that TAS requires a long procedure time, expensive equipment, and complex manipulations, TAS may be considered selectively for large NETs with suspected deep tumorous infiltration.

Citations

Citations to this article as recorded by

Endoscopic Resection of Rectal Neuroendocrine Tumors: Pathologic Risk Stratification and Surveillance Strategies
Ji Eun Kim
Journal of Digestive Cancer Research.2025; 13(3): 228. CrossRef

867 View
72 Download
1 Crossref

Statement

Cancer

Clinical practice guideline for endoscopic resection of early gastrointestinal cancer: Chan Hyuk Park, Dong-Hoon Yang, Jong Wook Kim, Jie-Hyun Kim, Ji Hyun Kim, Yang Won Min, Si Hyung Lee, Jung Ho Bae, Hyunsoo Chung, Kee Don Choi, Jun Chul Park, Hyuk Lee, Min-Seob Kwak, Bun Kim, Hyun Jung Lee, Hye Seung Lee, Miyoung Choi, Dong-Ah Park, Jong Yeul Lee, Jeong-Sik Byeon, Chan Guk Park, Joo Young Cho, Soo Teik Lee, Hoon Jai Chun; Intest Res 2021;19(2):127-157. Published online October 13, 2020; DOI: https://doi.org/10.5217/ir.2020.00020

Abstract PDF Supplementary Material PubReader ePub

Although surgery was the standard treatment for early gastrointestinal cancers, endoscopic resection is now a standard treatment for early gastrointestinal cancers without regional lymph node metastasis. High-definition white light endoscopy, chromoendoscopy, and image-enhanced endoscopy such as narrow band imaging are performed to assess the edge and depth of early gastrointestinal cancers for delineation of resection boundaries and prediction of the possibility of lymph node metastasis before the decision of endoscopic resection. Endoscopic mucosal resection and/or endoscopic submucosal dissection can be performed to remove early gastrointestinal cancers completely by en bloc fashion. Histopathological evaluation should be carefully made to investigate the presence of risk factors for lymph node metastasis such as depth of cancer invasion and lymphovascular invasion. Additional treatment such as radical surgery with regional lymphadenectomy should be considered if the endoscopically resected specimen shows risk factors for lymph node metastasis. This is the first Korean clinical practice guideline for endoscopic resection of early gastrointestinal cancer. This guideline was developed by using mainly de novo methods and encompasses endoscopic management of superficial esophageal squamous cell carcinoma, early gastric cancer, and early colorectal cancer. This guideline will be revised as new data on early gastrointestinal cancer are collected.

Citations

Citations to this article as recorded by

Distinct genomic, transcriptomic, and immune profiles for tumor and non-tumor mucosal regions in early gastric cancer
You Jeong Heo, Soomin Ahn, So Young Kang, Hyunjin Kim, Byung-Hoon Min, Kyoung-Mee Kim
Pathology - Research and Practice.2025; 266: 155768. CrossRef
Risk factors and predictive nomogram for non-curative resection in patients with early gastric cancer treated with endoscopic submucosal dissection: a retrospective cohort study
Lihua Guo, Yong Ding, Jinfeng Wen, Min Miao, Kefeng Hu, Guoliang Ye
World Journal of Surgical Oncology.2025;[Epub] CrossRef
High Frequency of RhoGAP Fusion and Muscularis Mucosae Invasion in pT1a Gastric Adenocarcinoma Harboring Lymph Node Metastasis
Chiina Hata, Hiroto Noda, Kaoru Nakano, Seiji Sakata, Kazuma Moriya, Satoko Baba, Toshiaki Hirasawa, Manabu Takamatsu, Emiko Sugawara, Noriko Yamamoto, Souya Nunobe, Takuji Gotoda, Kenichi Ohashi, Kengo Takeuchi, Hiroshi Kawachi
Pathology International.2025; 75(8): 414. CrossRef
Tissue engineering-based strategies of prevention and treatment for esophageal stenosis after endoscopic submucosal dissection
Fan Yang, Xiangyu Kong
Psycho-Oncologie.2025; 19(1s): 4565. CrossRef
Endoscopic submucosal dissection for superficial ultra-low rectal tumors: outcomes and predictive factors for procedure difficulty
Yinxin Wu
American Journal of Cancer Research.2024; 14(12): 5784. CrossRef
Outcomes Of Colorectal Endoscopic Submucosal Dissection According To The Size Of Colorectal Neoplasm: A HASID Multicenter Study
D. H. Kim, B. C. Jin, H. H. Oh, H. Y. Song, S. J. Kim, D. S. Myung, H. S. Kim, S. W. Kim, J. Lee, Y. E. Joo, G. S. Seo
Endoscopy.2024; 56(S 02): S210. CrossRef
A proposal for grading the risk of lymph node metastasis after endoscopic resection of T1 colorectal cancer
Zhenghua Piao, Rong Ge, Chunnian Wang
International Journal of Colorectal Disease.2023;[Epub] CrossRef
A DSC Test for the Early Detection of Neoplastic Gastric Lesions in a Medium-Risk Gastric Cancer Area
Valli De Re, Stefano Realdon, Roberto Vettori, Alice Zaramella, Stefania Maiero, Ombretta Repetto, Vincenzo Canzonieri, Agostino Steffan, Renato Cannizzaro
International Journal of Molecular Sciences.2023; 24(4): 3290. CrossRef
Chasm between Public Perceptions and Epidemiological Data on Colorectal Cancer
Su Bee Park, Min Seob Kwak, Jin Young Yoon, Jae Myung Cha
Gut and Liver.2023; 17(3): 449. CrossRef
Calcium, Vitamin D, and Colorectal Cancer
Young-Jo Wi, Soo-Young Na
The Korean Journal of Gastroenterology.2023; 82(2): 47. CrossRef
Effectiveness and Safety of Endoscopic Submucosal Dissection for Colorectal Neoplasm in Patients with High Charlson Comorbidity Index Score: A HASID Multicenter Study
Dong-Hyun Kim, Yong-Wook Jung, Byung-Chul Jin, Hyung-Hoon Oh, Hyo-Yeop Song, Seong-Jung Kim, Dae-Seong Myung, Sang-Wook Kim, Jun Lee, Geom-Seog Seo, Young-Eun Joo, Hyun-Soo Kim
Journal of Clinical Medicine.2023; 12(19): 6255. CrossRef
Endoscopic management of pseudo-lumen stapling following laparoscopic esophagojejunostomy: A case report
Seung Soo Lee
International Journal of Surgery Case Reports.2023; 111: 108830. CrossRef
Clinical characteristics and risk factors related to polyposis recurrence and advanced neoplasm development among patients with non-hereditary colorectal polyposis
Jihun Jang, Jihye Park, Soo Jung Park, Jae Jun Park, Jae Hee Cheon, Tae Il Kim
Intestinal Research.2023; 21(4): 510. CrossRef
Summary and comparison of recently updated post-polypectomy surveillance guidelines
Yoon Suk Jung
Intestinal Research.2023; 21(4): 443. CrossRef
Advanced Endoscopic Resection Techniques in Cirrhosis—A Systematic Review and Meta-Analysis of Outcomes
Saurabh Chandan, Smit Deliwala, Shahab R. Khan, Daryl Ramai, Babu P. Mohan, Mohammad Bilal, Antonio Facciorusso, Lena L. Kassab, Faisal Kamal, Banreet Dhindsa, Abhilash Perisetti, Douglas G. Adler
Digestive Diseases and Sciences.2022; 67(10): 4813. CrossRef
Prognosis and risk factors of electrocoagulation syndrome after endoscopic submucosal dissection in the colon and rectum. Large cohort study
Seong-Jung Kim, Su Young Kim, Jun Lee
Surgical Endoscopy.2022; 36(8): 6243. CrossRef
Comparison between Endoscopic Submucosal Dissection and Surgery in Patients with Early Gastric Cancer
Meng Qian, Yuan Sheng, Min Wu, Song Wang, Kaiguang Zhang
Cancers.2022; 14(15): 3603. CrossRef
Endoscopic methods for the detection and treatment of gastric cancer
Negar Niknam, Steven Obanor, Linda A. Lee
Current Opinion in Gastroenterology.2022; 38(5): 436. CrossRef
Association Between Family History of Gastric Cancer and the Risk of Gastric Cancer and Adenoma: A Nationwide Population-Based Study
Yoon Suk Jung, Mai Thi Xuan Tran, Boyoung Park, Chang Mo Moon
American Journal of Gastroenterology.2022; 117(8): 1255. CrossRef
Colonic Chicken Skin Mucosa Surrounding Colon Polyps Is an Endoscopic Predictive Marker for Colonic Neoplastic Polyps
Yu Mi Lee, Kyung Ho Song, Hoon Sup Koo, Choong-Sik Lee, Inseok Ko, Sang Hyuk Lee, Kyu Chan Huh
Gut and Liver.2022; 16(5): 754. CrossRef
Artificial intelligence-based colorectal polyp histology prediction using narrow-band image-magnifying colonoscopy: a stepping stone for clinical practice
Ji Young Chang
Clinical Endoscopy.2022; 55(5): 699. CrossRef
Feasibility of same-day discharge following endoscopic submucosal dissection for esophageal or gastric early cancer
Jing Wang, Shi-Jie Li, Yan Yan, Peng Yuan, Wei-Feng Li, Chang-Qi Cao, Wei-Gang Chen, Ke-Neng Chen, Qi Wu
World Journal of Gastroenterology.2022; 28(41): 5957. CrossRef
Endoscopic, clinicopathological, and growth characteristics of minute gastric cancer
Zhu Hui Liu, Shi Yuan Lu, Xiao Bo Li, Hui Min Chen, Hao Yan Chen, Xiao Yu Chen, Jing‐Yuan Fang, Yun Cui
Journal of Digestive Diseases.2022; 23(11): 628. CrossRef
Advances in the Aetiology & Endoscopic Detection and Management of Early Gastric Cancer
Darina Kohoutova, Matthew Banks, Jan Bures
Cancers.2021; 13(24): 6242. CrossRef

13,700 View
296 Download
27 Web of Science
24 Crossref

Original Article

Colorectal neoplasia

Clinical outcomes of submucosal colorectal cancer diagnosed after endoscopic resection: a focus on the need for surgery: Yun Sik Choi, Wan Soo Kim, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Byong Duk Ye, Seung-Jae Myung, Suk-Kyun Yang, Jeong-Sik Byeon; Intest Res 2020;18(1):96-106. Published online January 30, 2020; DOI: https://doi.org/10.5217/ir.2019.00092

Abstract PDF PubReader ePub

Background/Aims
We aimed to investigate the proportion of and risk factors for residual cancer and/or lymph node metastasis after surgery was performed because of high-risk pathological features in endoscopic resection specimen of suspected superficial submucosal colorectal cancer (SSMC).
Methods
We reviewed medical records of 497 patients (58.8 ± 9.8 years, 331 males) undergoing endoscopic resection of suspected SSMC. High-risk pathological features included: deep submucosal cancer invasion ≥ 1,000 μm; positive lymphovascular and/or perineural invasion; poorly differentiated adenocarcinoma; and positive resection margin. We investigated the occurrence of additional surgery and residual cancer and/or lymph node involvement in the surgical specimen.
Results
En bloc resection was performed in 447 patients (89.9%). High-risk pathological features were detected in 372 patients (74.8%). Additional surgery was performed in 336 of 372 patients with high-risk pathological features. Of these, 47 surgical specimens (14.0%) showed residual cancer and/or lymph node metastasis. Piecemeal resection was more common in those with residual cancer and/or lymph node involvement than those without (9/47 [19.1%] vs. 24/289 [8.3%], P= 0.032). Positive resection margin was also significantly associated with positive residual cancer and/or lymph node involvement. As the number of high-risk pathological features increased, the risk of regional lymph node metastasis increased proportionally (P= 0.002).
Conclusions
High-risk pathological features were frequently detected after endoscopic resection of suspected SSMC while residual cancer and/or lymph node metastasis were not commonly present in the additional surgical specimen. Further optimized strategy for proper endoscopic management of suspected SSMC is necessary.

Citations

Citations to this article as recorded by

Artificial Intelligence Models May Aid in Predicting Lymph Node Metastasis in Patients with T1 Colorectal Cancer
Ji Eun Baek, Hahn Yi, Seung Wook Hong, Subin Song, Ji Young Lee, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Byong Duk Ye, Seung-Jae Myung, Suk-Kyun Yang, Namkug Kim, Jeong-Sik Byeon
Gut and Liver.2025; 19(1): 69. CrossRef
Artificial Intelligence in Lymph Node Metastasis Prediction for T1 Colorectal Cancer: Promise and Challenges
Jung Ho Bae
Gut and Liver.2025; 19(1): 3. CrossRef
Survey of the Actual Practices Used for Endoscopic Removal of Colon Polyps in Korea: A Comparison with the Current Guidelines
Jeongseok Kim, Tae-Geun Gweon, Min Seob Kwak, Su Young Kim, Seong Jung Kim, Hyun Gun Kim, Sung Noh Hong, Eun Sun Kim, Chang Mo Moon, Dae Seong Myung, Dong-Hoon Baek, Shin Ju Oh, Hyun Jung Lee, Ji Young Lee, Yunho Jung, Jaeyoung Chun, Dong-Hoon Yang, Eun R
Gut and Liver.2025; 19(1): 77. CrossRef
Salvageable locoregional recurrence and stoma rate after local excision of pT1-2 rectal cancer – a nationwide cross-sectional cohort study
L.R. Moolenaar, E.G.M. van Geffen, S.J.A. Hazen, T.C. Sluckin, G.L. Beets, J.W.A. Leijtens, A.K. Talsma, J.H.W. de Wilt, P.J. Tanis, M. Kusters, R. Hompes, J.B. Tuynman, Arend G.J. Aalbers, Susanna M. van Aalten, Femke J. Amelung, Marjolein Ankersmit, Imo
European Journal of Surgical Oncology.2025; : 109623. CrossRef
Survival machine learning model of T1 colorectal postoperative recurrence after endoscopic resection and surgical operation: a retrospective cohort study
Zhihong Li, Yiliyaer Aihemaiti, Qianqian Yang, Yiliminuer Ahemai, Zimei Li, Qianqian Du, Yan Wang, Hanxiang Zhang, Yingbin Cai
BMC Cancer.2025;[Epub] CrossRef
AGA Clinical Practice Update on Endoscopic Resection for Early Colorectal Cancer: Commentary
Saowanee Ngamruengphong, Mohamed O. Othman, Andrew Y. Wang, Dennis Yang
Gastroenterology.2025; 169(7): 1558. CrossRef
Cutting Through the Debate: Surgical Resection Versus Surveillance-Based Approach for Kikuchi SM2/3 Colorectal Polyps
Izna Najam Syed, Noem Najam Syed, Lin Alkhiami, Bryony Bowman, Syed Umer Hannan, Deepak Singh-Ranger
Cureus.2025;[Epub] CrossRef
Problems and prospects of using morphological risk factors for lymph node metastasis in T1 colorectal cancer (review)
O. A. Mainovskaya
Koloproktologia.2025; 24(4): 177. CrossRef
Curative criteria for endoscopic treatment of colorectal cancer
Lucille Quénéhervé, Mathieu Pioche, Jérémie Jacques
Best Practice & Research Clinical Gastroenterology.2024; 68: 101883. CrossRef
Early Rectal Cancer and Local Excision: A Narrative Review
Cecilia Binda, Matteo Secco, Luigi Tuccillo, Chiara Coluccio, Elisa Liverani, Carlo Felix Maria Jung, Carlo Fabbri, Giulia Gibiino
Journal of Clinical Medicine.2024; 13(8): 2292. CrossRef
Prediction of Lymph Node Metastasis in T1 Colorectal Cancer Using Artificial Intelligence with Hematoxylin and Eosin-Stained Whole-Slide-Images of Endoscopic and Surgical Resection Specimens
Joo Hye Song, Eun Ran Kim, Yiyu Hong, Insuk Sohn, Soomin Ahn, Seok-Hyung Kim, Kee-Taek Jang
Cancers.2024; 16(10): 1900. CrossRef
How secure can we expect the surveillance policies to be after the implementation in T1 polyps with carcinoma?
Cristina Mateos Sanchez, Elvira Quintanilla Lazaro, Luis Ramon Rabago
World Journal of Gastrointestinal Endoscopy.2024; 16(9): 502. CrossRef
Comparative prediction of lymph node metastasis in pT1 colorectal cancer among Western and Japanese guidelines
Fumiaki Tanino, Ken Yamashita, Shin Morimoto, Yudai Takehara, Noriko Yamamoto, Yuki Kamigaichi, Tomoyuki Nishimura, Hidenori Tanaka, Hidehiko Takigawa, Yuji Urabe, Toshio Kuwai, Fumio Shimamoto, Shiro Oka
Frontiers in Oncology.2024;[Epub] CrossRef
The risk factors of lymph node metastasis in early colorectal cancer: a predictive nomogram and risk assessment
Jiahui Xu, Fan Yin, Linlin Ren, Yushuang Xu, Congcong Min, Peng Zhang, Mengyu Cao, Xiaoyu Li, Zibin Tian, Tao Mao
International Journal of Colorectal Disease.2024;[Epub] CrossRef
Comment on " Positive fecal immunochemical test results are associated with non-colorectal cancer mortality"
Yong Eun Park
The Korean Journal of Internal Medicine.2023; 38(2): 264. CrossRef
Long-term outcomes after endoscopic versus surgical resection of T1 colorectal carcinoma
Hyun Jin Bae, Hoyeon Ju, Han Hee Lee, Jinsu Kim, Bo-In Lee, Sung Hak Lee, Daeyoun David Won, Yoon Suk Lee, In Kyu Lee, Young-Seok Cho
Surgical Endoscopy.2023; 37(2): 1231. CrossRef
Comparative Cost Analysis Between Endoscopic Resection and Surgery for Submucosal Colorectal Cancer
Soo Min Noh, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Byong Duk Ye, In Ja Park, Seok-Byung Lim, Jeong-Sik Byeon
Diseases of the Colon & Rectum.2023; 66(5): 723. CrossRef
Incidence of colonoscopy-related perforation and risk factors for poor outcomes: 3-year results from a prospective, multicenter registry (with videos)
Jieun Lee, Yoo Jin Lee, Jong Won Seo, Eun Soo Kim, Sung Kook Kim, Min Kyu Jung, Jun Heo, Hyun Seok Lee, Joon Seop Lee, Byung Ik Jang, Kyeong Ok Kim, Kwang Bum Cho, Eun Young Kim, Dae Jin Kim, Yun Jin Chung
Surgical Endoscopy.2023; 37(8): 5865. CrossRef
Usage trends of colorectal endoscopic submucosal dissection according to hospital types based on nationwide claims data
Ji Eun Na, Bohyoung Kim, Sung Hoon Jung, Arum Choi, Sukil Kim, Tae-Oh Kim
Medicine.2023; 102(43): e35514. CrossRef
Risk and Time Pattern of Recurrences After Local Endoscopic Resection of T1 Colorectal Cancer: A Meta-analysis
Hao Dang, Nik Dekkers, Saskia le Cessie, Jeanin E. van Hooft, Monique E. van Leerdam, Philip P. Oldenburg, Louis Flothuis, Jan W. Schoones, Alexandra M.J. Langers, James C.H. Hardwick, Jolein van der Kraan, Jurjen J. Boonstra
Clinical Gastroenterology and Hepatology.2022; 20(2): e298. CrossRef
Emergence of a New Optical Marker for Colorectal Neoplasms: To What Extent Should We Accept It?
Han Hee Lee
Clinical Endoscopy.2022; 55(2): 315. CrossRef
Deep Submucosal Invasion Is Not an Independent Risk Factor for Lymph Node Metastasis in T1 Colorectal Cancer: A Meta-Analysis
Liselotte W. Zwager, Barbara A.J. Bastiaansen, Nahid S.M. Montazeri, Roel Hompes, Valeria Barresi, Katsuro Ichimasa, Hiroshi Kawachi, Isidro Machado, Tadahiko Masaki, Weiqi Sheng, Shinji Tanaka, Kazutomo Togashi, Chihiro Yasue, Paul Fockens, Leon M.G. Moo
Gastroenterology.2022; 163(1): 174. CrossRef
Utility of artificial intelligence with deep learning of hematoxylin and eosin-stained whole slide images to predict lymph node metastasis in T1 colorectal cancer using endoscopically resected specimens; prediction of lymph node metastasis in T1 colorecta
Joo Hye Song, Yiyu Hong, Eun Ran Kim, Seok-Hyung Kim, Insuk Sohn
Journal of Gastroenterology.2022; 57(9): 654. CrossRef
Endoscopic diagnosis and treatment of early colorectal cancer
Seung Wook Hong, Jeong-Sik Byeon
Intestinal Research.2022; 20(3): 281. CrossRef
Long-term prognosis of curative endoscopic submucosal dissection for early colorectal cancer according to submucosal invasion: a multicenter cohort study
Jongbeom Shin, Eun Ran Kim, Hyun Joo Jang, Dong Hoon Baek, Dong-Hoon Yang, Bo-In Lee, Kwang Bum Cho, Jin Woong Cho, Sung-Ae Jung, Su Jin Hong, Bong Min Ko, Jung-Won Jeon, Weon Jin Ko, Sun Moon Kim, Young Dae Kim, Kim Chan Gyoo, Gwang Ho Baik, In Kyung Yoo
BMC Gastroenterology.2022;[Epub] CrossRef
Artificial intelligence-based colorectal polyp histology prediction using narrow-band image-magnifying colonoscopy: a stepping stone for clinical practice
Ji Young Chang
Clinical Endoscopy.2022; 55(5): 699. CrossRef

9,536 View
199 Download
24 Web of Science
26 Crossref

First
Prev
Page of 1
Next
Last

Search