Comparing Endoscopy and Surgery: A Systematic Review of Early Colorectal Cancer Treatments

Abstract

Colorectal cancer is a major type of gastrointestinal
cancer that significantly contributes to disease burden
and mortality, particularly among younger people. Early
colorectal cancer refers to the early stages of the
disease that require early detection and treatment to
improve the overall prognosis and survival. There are
various treatment options available for early colorectal
cancer, such as endoscopic resection, including methods
like transanal endoscopic microsurgery (TEMS),
endoscopic mucosal resection (EMR), or submucosal
dissection (ESD), as well as surgical resection, including
open and laparoscopic techniques. However, to make
informed decisions about which approach is best, it is
crucial to thoroughly understand the long-term
outcomes associated with each option. We
systematically reviewed the PubMed and Google Scholar
databases from 2013 to August 11, 2023, to obtain such
knowledge. We selected nine for in-depth analysis after
carefully reviewing 2761 articles, including those
written in English and focusing on human studies. The
review focused on individual benefits, merits, and
drawbacks, considering the extent of the disease,
clinical outcomes, survival, and complication rates.
Although endoscopic resection has the advantage of
being less invasive and promoting faster patient
recovery, it should be noted that its primary objective
may not necessarily be achieving complete excision
(R0). This is because there are potential obstacles,
including inadequate lymph node removal and
inaccurate T staging that may prevent the achievement
of R0. Nevertheless, it is important to stress that both
endoscopic and surgical resection ultimately share the
goal of complete excision and curing the patient. Finally,
this systematic review emphasizes the need for
additional research to fill knowledge gaps, improve
clinical decision-making, and promote the application of
sophisticated technology. As the landscape of early
colorectal cancer treatment evolves, a balanced
integration of endoscopic and surgical resection
procedures, together with emerging technologies, can
improve patient outcomes and increase treatment
efficacy.