Endoscopic resection after neoadjuvant therapy for advanced rectal cancer with near-complete response: a retrospective multicentre case series
Menée à l'aide de données multicentriques 2018-2025 portant sur 42 patients atteints d'un cancer du rectum localement avancé et présentant des lésions rectales résiduelles d'aspect superficiel après réponse clinique quasi complète aux traitements néoadjuvants (âge médian : 68 ans), cette étude évalue la faisabilité et la sécurité d'une résection endoscopique
Background: Radical surgery after neoadjuvant therapy remains standard for locally advanced rectal cancer but carries substantial postoperative morbidity. With near-complete clinical response (near-cCR) and superficial-appearing residual disease, endoscopic resection may offer an organ-preserving alternative, although evidence for safety and oncological efficacy remains limited.
Objective: To evaluate feasibility, safety and oncological outcomes of endoscopic resection for superficial residual rectal neoplasia in patients with near-cCR after various neoadjuvant therapies.
Design: Multicentre retrospective case series from 12 centres (2018–2025) of patients with presumed superficial residual neoplasia based on endoscopy and cross-sectional imaging excluding lymph node involvement or distant metastases. Primary outcomes: technical success, safety, R0 resection and recurrence.
Results: Among 42 patients (median age 68 years) treated with endoscopic submucosal dissection (43%) or deeper resection techniques, en bloc and R0 resection rates were 97.6% and 85.4%, respectively. Histology showed hyperplasia/adenoma in 52.4%, T1 cancer in 35.7% and ≥T2 cancer in 11.9%, with cancer in 28% of Japanese Narrow Band Imaging Expert Team (JNET) type 2 lesions (all but one T1) and 80% of JNET type 3 lesions, one-third >T1. Six underwent surgery for incomplete resection or lesion risk features. Among remaining patients, median follow-up was 29 months. Recurrence occurred in 16% (four endoluminal, one locoregional, one solitary lung metastasis). Adverse events occurred in 7.3%, all grade ≤2; major low anterior resection syndrome occurred in 10% of 29 evaluable patients.
Conclusions: Endoscopic resection appears feasible for selected near-cCR patients after neoadjuvant therapy. Residual tumour extent remains difficult to predict, but JNET type 3 may indicate disease less amenable to endoscopic resection.All data relevant to the study are included in the article or uploaded as supplementary information.
Gut , résumé, 2026