Early Rectal Cancer: Diagnostic Challenges and the Role of Endoscopic Intermuscular Dissection Within the Therapeutic...

Area of Science:

• Gastroenterology
• Surgical Oncology
• Medical Imaging

Background:

• Accurate locoregional staging is crucial for early rectal cancer treatment.
• Current methods like MRI and EUS have limitations in T staging for early disease.
• This diagnostic gap complicates therapeutic decisions, especially for deep submucosal invasion.

Purpose of the Study:

• To review diagnostic gaps in early rectal cancer staging.
• To define the potential role of endoscopic intermuscular dissection (EID) in the therapeutic algorithm.

Main Methods:

• Narrative review of current diagnostic and therapeutic strategies.
• Analysis of limitations in MRI and EUS for early rectal cancer.
• Exploration of EID as a novel endoscopic resection technique.

Main Results:

• MRI and EUS exhibit significant limitations in T staging for early rectal cancer.
• Endoscopic submucosal dissection (ESD) may be insufficient for deep submucosal invasion.
• EID allows dissection in the intermuscular plane for curative resection with preserved rectal integrity.

Conclusions:

• There is a critical need for improved diagnostic accuracy in early rectal cancer.
• EID presents a promising therapeutic option for selected cases, potentially avoiding radical surgery.
• Further research is needed to establish EID's place in the standard treatment algorithm.