Background and Aims
The standard treatment of locally advanced rectal cancer is chemoradiation (CRT) followed
by proctectomy and adjuvant chemotherapy. However, there is an emerging role for nonsurgical
management after CRT or total neoadjuvant therapy (TNT) consisting of CRT and neoadjuvant
chemotherapy. Endoscopic submucosal dissection (ESD) after CRT or TNT for rectal cancer,
termed “salvage ESD,” may be a viable nonsurgical option for carefully selected patients.
We aimed to evaluate the feasibility and safety of salvage ESD.
Methods
A retrospective chart review of cases of salvage ESD for locally advanced rectal cancer
and standard ESD for rectal tumors without prior CRT from July 2018 to August 2020
at our institution was performed. Clinical factors and imaging, procedural, and pathology
results were collected and compared.
Results
Twelve salvage ESD cases were compared with 27 standard ESD cases. Before CRT, 83.3%
of lesions in the salvage ESD group were initially clinically staged as T3. The en-bloc
resection rates were 92.7% and 91.7% (P = 1.00) and R0 resection rates 66.7% and 75.0% (P = .55) for the standard and salvage groups, respectively. In the salvage ESD group,
no adverse events were observed, and 75.0% of the adenocarcinomas in the salvage ESD
group had morphologically changed to hyperplasia or adenoma after CRT, with no identifiable
lesions greater than T1 tumor depth.
Conclusions
Salvage ESD for locally advanced rectal cancer is technically feasible with low adverse
event rates. There may be a diagnostic role in salvage ESD in assessing pathologic
response to CRT and a possible therapeutic role in resection of residual lesions with
the potential to avoid surgery.
Abbreviations:
CRT (chemoradiation), ESD (endoscopic submucosal dissection), JNET (Japan NBI Expert Team), PCM (pocket-creation method), pCR (pathologic complete response), TNT (total neoadjuvant therapy)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 17, 2022
Accepted:
February 9,
2022
Received:
December 1,
2021
Footnotes
DISCLOSURE: The following authors disclosed financial relationships: M. Nishimura: Consultant for Boston Scientific, Olympus America, and Lumendi. M. A. Schattner: Consultant for Boston Scientific; advisory board for Novo Nordisk. J. Garcia-Aguilar: Consultant for Ethicon, J&J, and Intuitive Surgical; equity in Intuitive Surgical. M. Weiser: Tumor board member for PreciCa; research funding from Clinical Genomics; section editor of UpToDate. All other authors disclosed no financial relationships.
DIVERSITY, EQUITY, AND INCLUSION: We worked to ensure gender balance in the recruitment of human subjects. One or more of the authors of this paper self-identifies as an under-represented gender minority in science. One or more of the authors of this paper self-identifies as an under-represented ethnic minority in science. The author list of this paper includes contributors from the location where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.
If you would like to chat with an author of this article, you may contact Dr Leung at [email protected]
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© 2022 by the American Society for Gastrointestinal Endoscopy
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- Is there a role for salvage endoscopic submucosal dissection after chemoradiation for locally advanced rectal cancer?Gastrointestinal EndoscopyVol. 96Issue 2
- PreviewFor decades, surgical resection has been the cornerstone for the treatment of locally advanced rectal adenocarcinoma (LARC). Recently, this paradigm has been questioned, with an organ-preserving watch-and-wait approach. After neoadjuvant chemoradiotherapy (nCRT), patients with complete clinical response are surveyed closely, and incomplete responders undergo total mesorectal excision. Given the operative morbidity and mortality associated with total mesorectal excision, this watch-and-wait approach is attractive for those who want to try to avoid surgery.
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