Comparison of efficacy and safety between endoscopic mucosal dissection and resection in the treatment of early gastrointestinal cancer and precancerous lesions: a systematic review and meta-analysis

Background: Endoscopic mucosal dissection (EMD) is a new treatment method. Whether its clinical efficacy and safety are superior to surgical resection is still controversial. The sample size of previous studies on EMD for the treatment of early cancer of digestive tract is small, and there is no reliable evidence at present. Therefore, it is necessary to evaluate the efficacy and safety of EMD based on the evidence of evidence-based medicine. Methods: The PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure, Wanfang, cqvip.com (VIP), websites and citation searching were searched to obtain relevant literature on EMD for early cancer and precancerous lesions of digestive tract. The retrieval time was from the establishment of the database to November 29th, 2022. Literature was screened according to inclusion and exclusion criteria and data and data were extracted. The final included literature was assessed by Cochrane risk of bias tool, and publication bias was assessed by Egger's test. Results: A total of 10 articles were included, with a total of 1,165 patients. Among these, 585 cases were treated with EMD and 580 cases were in the control group. The literature quality evaluation found that 5 articles had low risk of bias and 5 articles had unclear risk of bias. The results showed that the complete resection rate in the observation group was higher than that in the control group [risk ratio (RR) =1.25, 95% confidence interval (CI): 1.15-1.35, P<0.01]. Cumulative intraoperative blood loss (P<0.01), operation time (P<0.01), postoperative complications (P<0.01), hospital stay (P<0.01), and hospitalization expenses (P<0.01) in the observation group were lower than those in the control group. Conclusions: EMD for early gastrointestinal cancer and precancerous lesions can improve the complete resection rate of tumors; reduce intraoperative blood loss, complications, operation time, and hospitalization time and cost. However, due to the small number of literatures included in this paper, the quality of literatures is not high, and some results have heterogeneous interference, the conclusion needs to include more high-treatment studies for further study.