This study evaluates how advanced endoscopic resection techniques affect treatment outcomes in adults with rectal cancer.
Rectal cancer has traditionally been treated with standard abdominal surgery. Newer endoscopic techniques allow removal of selected early tumors and may reduce treatment-related complications. However, their effectiveness and safety in tumors with deeper invasion are not yet fully established.
This multicenter retrospective observational study uses existing medical records from adults who underwent endoscopic or surgical resection of rectal tumors between 2015 and 2025. Researchers will analyze anonymized information on procedures performed and treatment outcomes to assess the safety and effectiveness of advanced endoscopic approaches.
The results of this study may help guide treatment selection and improve care for people with rectal cancer.
Patients with rectal neoplasms treated by advanced endoscopic resection
hybrid resection performed
full-thickness resection performed
essential procedural or outcome data were unavailable
Patients with rectal neoplasms treated with advanced endoscopic resection in a tertiary center.
Cohort
Retrospective
Endoscopic submucosal dissection
Procedure/SurgeryEndoscopic submucosal dissection is an advanced endoscopic technique used to remove rectal tumors in one piece through the endoscope. A circumferential incision is then made in the mucosa, followed by careful dissection within the submucosal layer until the lesion is completely removed. This technique enables precise pathological assessment of tumor margins and depth of invasion and is typically used for lesions suspected to have superficial submucosal invasion without clear evidence of lymph node involvement. The procedure is performed using standard therapeutic endoscopic equipment and electrosurgical devices.
Endoscopic intramuscular dissection
Procedure/SurgeryEndoscopic intermuscular dissection is an advanced endoscopic resection technique designed for rectal tumors with suspected deeper submucosal invasion. Following mucosal incision, the dissection is intentionally performed in the plane between the inner circular and outer longitudinal muscle layers of the rectal wall. This allows deeper en bloc tumor removal compared with conventional endoscopic submucosal dissection. The goal of this technique is to achieve complete resection while potentially avoiding radical surgery in selected patients. The procedure is performed endoscopically using specialized dissection knives and electrosurgical systems and requires advanced operator expertise.
Major intraprocedural bleeding rate
Bleeding occurring during the procedure that required advanced endoscopic hemostatic interventions beyond standard coagulation with the tip of the knife of coagulation forceps, resulted in hemodynamic instability, caused a significant prolongation of the procedure over 15 minutes (based on video), or led to procedure interruption or conversion
Intraprocedural perforation rate
Full-thickness defect of the gastrointestinal wall identified during the procedure, evidenced by direct visualization of extraluminal structures (mesorectum or peritoneal cavity), or confirmed by the presence of free air on imaging performed immediately after the procedure.
Delayed bleeding rate
Symptomatic bleeding including hematemesis, melena, or a hemoglobin decrease of more than 2 g/dL.
Delayed perforation rate
Clinical signs of peritonitis accompanied by radiological evidence of free intraperitoneal air.
En bloc resection rate
The rate of lesions removed in a single specimen, enabling accurate macroscopic and histological assessment as reported by an endoscopist in a procedure protocol.
Complete resection rate
The rate of lesions resected completely according to the pathological examination of the resected specimen.
Procedure time
Procedure time was evaluated on the procedure video and defined as the interval from the insertion of the scope to its final withdrawal measured in minutes; anesthesia-related time was not included.
Length of hospital stay
The number of days from the day of the procedure (day 0) to the day of hospital discharge.
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