Leon M G Moons1, Barbara A J Bastiaansen2, Milan C Richir3, Wouter L Hazen4, Jurriaan Tuynman5, Sjoerd G Elias6, Ruud W M Schrauwen7, Frank P Vleggaar1, Evelien Dekker2, Philip Bos8, Arantza Fariña Sarasqueta9, Miangela Lacle10, Roel Hompes5, Paul Didden1. 1. Department of Gastroenterology & Hepatology, UMC Utrecht, Utrecht, The Netherlands. 2. Department of Gastroenterology & Hepatology, Amsterdam UMC, Amsterdam, The Netherlands. 3. Department of Surgery, UMC Utrecht, Utrecht, The Netherlands. 4. Department of Gastroenterology & Hepatology, Elizabeth Tweesteden Ziekenhuis, Tilburg, The Netherlands. 5. Department of Surgery, Amsterdam UMC, Amsterdam, The Netherlands. 6. Department of Epidemiology, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands. 7. Department of Gastroenterology & Hepatology, Bernhoven, Uden, The Netherlands. 8. Department of Gastroenterology & Hepatology, Gelderse Vallei, Ede, The Netherlands. 9. Department of Pathology, Amsterdam UMC, Amsterdam, The Netherlands. 10. Department of Pathology, UMC Utrecht, Utrecht, The Netherlands.
Abstract
BACKGROUND: The risk of lymph node metastasis associated with deep submucosal invasion should be balanced against the mortality and morbidity of total mesorectal excision (TME). Dissection through the submucosa hinders radical deep resection, and full-thickness resection may influence the outcome of completion TME. Endoscopic intermuscular dissection (EID) in between the circular and longitudinal part of the muscularis propria could potentially provide an R0 resection while leaving the rectal wall intact. METHODS: In this prospective cohort study, the data of patients treated with EID for suspected deep submucosal invasive rectal cancer between 2018 and 2020 were analyzed. Study outcomes were the percentages of technical success, R0 resection, curative resection, and adverse events. RESULTS: 67 patients (median age 67 years; 73 % men) were included. The median lesion size was 25 mm (interquartile range 20-33 mm). The rates of overall technical success, R0 resection, and curative resection were 96 % (95 %CI 89 %-99 %), 81 % (95 %CI 70 %-89 %), and 45 % (95 %CI 33 %-57 %). Only minor adverse events occurred in eight patients (12 %). CONCLUSION: EID for deep invasive T1 rectal cancer appears to be feasible and safe, and the high R0 resection rate creates the potential of rectal preserving therapy in 45 % of patients. Thieme. All rights reserved.
BACKGROUND: The risk of lymph node metastasis associated with deep submucosal invasion should be balanced against the mortality and morbidity of total mesorectal excision (TME). Dissection through the submucosa hinders radical deep resection, and full-thickness resection may influence the outcome of completion TME. Endoscopic intermuscular dissection (EID) in between the circular and longitudinal part of the muscularis propria could potentially provide an R0 resection while leaving the rectal wall intact. METHODS: In this prospective cohort study, the data of patients treated with EID for suspected deep submucosal invasive rectal cancer between 2018 and 2020 were analyzed. Study outcomes were the percentages of technical success, R0 resection, curative resection, and adverse events. RESULTS: 67 patients (median age 67 years; 73 % men) were included. The median lesion size was 25 mm (interquartile range 20-33 mm). The rates of overall technical success, R0 resection, and curative resection were 96 % (95 %CI 89 %-99 %), 81 % (95 %CI 70 %-89 %), and 45 % (95 %CI 33 %-57 %). Only minor adverse events occurred in eight patients (12 %). CONCLUSION: EID for deep invasive T1 rectal cancer appears to be feasible and safe, and the high R0 resection rate creates the potential of rectal preserving therapy in 45 % of patients. Thieme. All rights reserved.