The 7th Joint Session between JDDW-KDDW-TDDW1(JDDW)
Thu. November 2nd   9:00 - 12:00   Room 9: Portopia Hotel Main Building Kairaku 3
JKT1-RS3
 Role of endoscopic muscular dissection for rectal cancer with clinical complete response after concurrent chemoradiotherapy
Chao-Wen Hsu1, Chu-Kuang Chou2, Jen-Hao Yeh3
1Division of Colorectal Surgery, Kaohsiung Veterans General Hospital, 2Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, 3Department of Internal Medicine, E-Da Hospital
Background
For clinical T2N+/- or T3N+/- rectal cancer, concurrent chemoradiotherapy (CCRT) followed by radical low anterior resection (LAR) +/- diversion stoma is the standard treatment modality. The clinical complete response (cCR) rate after CCRT can achieve 10-20% based on the modern total neoadjuvant therapy (TNT) and neoadjuvant chemotherapy. Endoscopic muscular dissection (EMD) for cCR rectal cancer after CCRT, may play a diagnostic role to decide watch & wait (WW) or radical LAR in carefully selected patients. We retrospectively evaluated the technical feasibility and the short-term outcome of EMD for rectal cancer with cCR after CCRT.

Methods
A retrospective chart review of cases of EMD for rectal cancer with cCR after CCRT from Jan 2022 to Aug 2023 at our institution was performed. Clinical factors and imaging, procedural, and pathology results were collected and analyzed.

Results
Eight EMD for rectal cancer with cCR were performed. Before CCRT, 6 of lesions were initially clinically staged as T2-3N0 and 2 were T3N1. The en-bloc resection rates and R0 resection were 100% without complications. Six lesions had pathologically complete response (pCR), 1 lesion had morphologically changed to adenoma and 1 lesion had minimal residual ypT1. No patients received subsequent radical LAR in this cohort.

Conclusions
EMD for rectal cancer with cCR after CCRT is technically feasible with low complication rates. There may be a diagnostic role in EMR in assessing pathologic response after CCRT and a potentially therapeutic role to avoid radical LAR in carefully selected patients.
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