Related Experiment Video
Updated: Aug 10, 2026
Intraoperative Gastroscopy for Tumor Localization in Laparoscopic Surgery for Gastric Adenocarcinoma
Published on: August 9, 2016
Predictive Value of Endoscopy in the Identification of Complete Response After Neoadjuvant Therapy for Rectal
Yu Shen1, Anqing Lu2, Zhao Zhang3
1Colorectal Cancer Center, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China.
Background:
Large-scale evidence on the role of endoscopy alone as the assessment tool to identify complete response after neoadjuvant therapy in locally advanced rectal cancer, particularly across different neoadjuvant therapy regimens, is scarce.
Objective:
This study aims to evaluate the diagnostic accuracy of endoscopy for predicting luminal complete response after neoadjuvant therapy and compare its performance between patients receiving neoadjuvant chemotherapy and neoadjuvant chemoradiotherapy.
Design:
Retrospective cohort study.
Settings:
The study was conducted at a teaching hospital.
Patients:
A total of 349 locally advanced rectal cancer patients (223 neoadjuvant chemotherapy, 126 neoadjuvant chemoradiotherapy) who underwent neoadjuvant therapy and restaging endoscopy were included.
Interventions:
Three reviewers assessed endoscopic images independently to determine the occurrence of endoscopic complete response.
Main Outcome Measures:
The diagnostic accuracy for predicting pathological luminal complete response (ypT0) was calculated.
Results:
The overall accuracy of endoscopy for predicting complete response was 92.0% (321/349), with a positive predictive value of 69.6%, sensitivity of 69.6% and specificity of 95.4%. A flat scar was the most predictive feature (positive predictive value = 70.3%). The sensitivity of endoscopic performance was significantly higher in the neoadjuvant chemoradiotherapy group compared to the neoadjuvant chemotherapy group (90.0% vs. 53.8%, p = 0.008), despite comparable overall accuracy and area under the curve. The addition of biopsy did not significantly improve diagnostic ability. Inter-reviewer agreement was substantial to excellent (κ=0.754-0.883).
Limitations:
No video or artificial intelligence was involved.
Conclusions:
Endoscopy is an optional tool for identifying luminal complete response after neoadjuvant therapy. Its sensitivity is lower after neoadjuvant chemotherapy than after neoadjuvant chemoradiotherapy, warranting caution against missed diagnoses. Beyond the flat scar, other features like small flat ulcers also have a non-negligible complete response rate. The role of routine biopsy still needs further exploration. See Video Abstract.
More Related Videos
06:46Competing-Risk Nomogram for Predicting Cancer-Specific Survival in Multiple Primary Colorectal Cancer Patients after Surgery
Published on: September 27, 2024
07:13Comparison of Predictive Performance of Three Lymph Node Staging Systems in Colorectal Signet Ring Cell Carcinoma Based on Machine Learning Model
Published on: April 18, 2025