Physical recovery after local resection of nonpedunculated rectal adenomas and T1 carcinomas: endoscopic submucosal dissection versus transanal minimally invasive surgery

Background and Aims: Rehabilitation of physical activity is an important functional outcome after endoscopic surgery. Our aim was to quantitatively assess recovery after endoscopic submucosal dissection (ESD) and transanal minimally invasive surgery (TAMIS). Methods: In the TRIASSIC study (Netherlands Trial Registry: NL7083), patients with rectal polyps >20 mm were randomized between ESD and TAMIS. This ancillary study used smartwatches to track activity data for a 14-day preoperative baseline period and a 28-day postoperative recovery period. The primary end point for noninferiority was the mean time to recovery (≥90% of baseline step count for 2 consecutive days), assessed by means of Weibull regression with a 7-day noninferiority margin. Results: Forty patients were included: 20 ESD and 20 TAMIS procedures. Median lesion size was 42.5 mm (interquartile range [IQR], 25-50), with 17.5% pT1RCs and 82.5% nonmalignant rectal polyps. Compliance with smartwatch measurements was 98.4% (IQR, 94.2-100). Within the 28-day timespan, 17 patients (85%) in the ESD group recovered and 15 (75%) in the TAMIS group (P = .43). Mean recovery times were 13.9 days for ESD and 21.0 days for TAMIS, indicating noninferiority of ESD (95% confidence interval of difference, −3.41 to 20.25). Recovery as measured by smartwatch significantly correlated with self-reported recovery (Spearman rho, 0.644; P < .001). Moderate to severe pain scores (≥4 out of 10) were reported by 15 patients (42.9%): in 27.8% of the ESD group and 58.9% of the TAMIS-group (P = .06). Increased pain scores were significantly associated with decreased physical activity (P < .01). Conclusions: In terms of mean time to physical recovery, ESD was noninferior to TAMIS. Post-procedural pain was significantly associated with reduced physical activity.