Sekra A, Tan T. Endoscopic intermuscular dissection for locally advanced rectal cancer: A case report. World J Surg Proced 2023; 13(3): 22-28 [DOI: 10.5412/wjsp.v13.i3.22]
Corresponding Author of This Article
Anurag Sekra, FRACP, MBBS, MD, Doctor, Department of Gastroenterology and Hepatology, Te Whatu Ora, Counties Manukau Health, No. 100 Hospital Road, Otahuhu, Auckland 2025, New Zealand. doctorsekra@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Surg Proced. Dec 28, 2023; 13(3): 22-28 Published online Dec 28, 2023. doi: 10.5412/wjsp.v13.i3.22
Endoscopic intermuscular dissection for locally advanced rectal cancer: A case report
Anurag Sekra, Tracy Tan
Anurag Sekra, Department of Gastroenterology and Hepatology, Te Whatu Ora, Counties Manukau Health, Auckland 2025, New Zealand
Tracy Tan, Department of Pathology, Te Whatu Ora, Counties Manukau Health, Auckland 2025, New Zealand
Author contributions: Sekra A performed the procedure and wrote the manuscript, Tan T reported the pathology and described the pathology figure in the manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Anurag Sekra, FRACP, MBBS, MD, Doctor, Department of Gastroenterology and Hepatology, Te Whatu Ora, Counties Manukau Health, No. 100 Hospital Road, Otahuhu, Auckland 2025, New Zealand. doctorsekra@gmail.com
Received: October 13, 2023 Peer-review started: October 14, 2023 First decision: October 24, 2023 Revised: November 8, 2023 Accepted: November 21, 2023 Article in press: November 21, 2023 Published online: December 28, 2023 Processing time: 74 Days and 5.8 Hours
Abstract
BACKGROUND
Endoscopic submucosal dissection is considered curative for patients with early rectal cancer when level of submucosal invasion is < 1000 microns with favourable histopathological features. Recent data suggests even deeper submucosal invasion can potentially be curative if R0 resection can be achieved and when no high-risk histopathological features are seen in the resected specimen. To achieve R0 resection, deeper dissection is required.
CASE SUMMARY
A 66 year old New Zealand European male presented with 3 mo history of per rectal bleeding. He was referred for a colonoscopy test to investigate this further. This revealed a malignant appearing lesion in the rectum. Biopsies however showed high grade dysplasia only. Given endoscopic appearances suspicious for deep submucosal invasion, patient was consented for endoscopic intermuscular dissection (EID). The case was successfully performed, and the presence of muscularis propria was confirmed in the resected specimen. There were no complications and total procedure time was 124 min. Lesion was clear of radial margins however deep margins were positive confirming it was at least a pT2 cancer. Patient was recommended to have further treatment but could not have radical surgery due to comorbidities and instead was referred for long course chemoradiotherapy.
CONCLUSION
EID is a safe and feasible option for management of rectal cancer in highly selected patients.
Core Tip: Endoscopic intermuscular dissection is a novel technique for management of locally advanced rectal cancer especially for patients who are not fit for oncological surgery or chemoradiotherapy. This technique ensures local resection of the tumour which is safe and feasible with minimal recovery times.
