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Related Experiment Video

Updated: Jan 17, 2026

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Expanding Organ Preservation in Locally Advanced Rectal Cancer After Total Neoadjuvant Therapy With Endoscopic

Emre Gorgun1, Kamil Erozkan, Salih N Karahan

  • 1Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio.

Diseases of the Colon and Rectum
|September 15, 2025
PubMed
Summary

Endoscopic submucosal dissection (ESD) offers a feasible and safe organ preservation option for select rectal cancer patients achieving near-complete response or experiencing regrowth after total neoadjuvant therapy (TNT). Further prospective trials are needed to confirm its long-term value.

Keywords:
Endoscopic submucosal dissectionOrgan preservationRectal cancerTotal neoadjuvant therapyWatch and wait

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Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Colorectal Surgery

Background:

  • Organ preservation in locally advanced rectal cancer (LARC) after total neoadjuvant therapy (TNT) hinges on complete clinical response and vigilant surveillance.
  • Patients with near-complete response or tumor regrowth during watch-and-wait protocols typically require total mesorectal excision (TME).
  • Local resection techniques, including endoscopic submucosal dissection (ESD), present potential avenues for expanding organ preservation strategies in selected LARC cases.

Purpose of the Study:

  • To evaluate the feasibility, safety, and clinical outcomes of employing endoscopic submucosal dissection (ESD).
  • To assess ESD's efficacy in patients with locally advanced rectal cancer (LARC) exhibiting near-complete response or tumor regrowth post-total neoadjuvant therapy (TNT).
  • To determine the organ preservation and regrowth rates following ESD in this specific patient cohort.

Main Methods:

  • A retrospective cohort study was conducted at a single tertiary care center.
  • Included were 20 patients with LARC treated with TNT between 2015 and 2024, who underwent ESD for near-complete response or regrowth during active surveillance.
  • The primary outcome measures focused on organ preservation rates and tumor regrowth following ESD.

Main Results:

  • Fourteen out of twenty patients (70%) had no invasive cancer upon pathological examination of ESD specimens.
  • Ten patients underwent ESD for near-complete response, while another ten received ESD due to tumor regrowth (median 12.5 months post-TNT).
  • After a mean follow-up of 27.7 months, fourteen patients remain under surveillance with no evidence of disease; five required subsequent TME due to invasive adenocarcinoma found during ESD.

Conclusions:

  • Selective endoscopic submucosal dissection (ESD) appears to be a feasible and safe organ-preserving approach for highly selected patients with locally advanced rectal cancer (LARC) after total neoadjuvant therapy (TNT).
  • The study highlights the potential of ESD to avoid radical surgery in a significant proportion of patients.
  • Larger prospective studies with extended follow-up are essential to validate the long-term efficacy and role of ESD in LARC management.