关键词: 进展期直肠癌, 器官保留, 内镜下全层切除术, 新辅助放化疗, 安全性及有效性

Abstract: To evaluate the feasibility and safety of endoscopic full thickness resection (EFTR) in rectal cancer patients achieving a near clinical complete response (ncCR) following neoadjuvant therapy. Methods    A retrospective analysis was conducted on mid-to-low rectal cancer patients who underwent neoadjuvant therapy at Zhongshan Hospital, Fudan University between October 2021 and March 2024. Patients who, upon re-evaluation, achieved ncCR and subsequently underwent EFTR were included. The primary analysis was based on perioperative complications, pathological outcomes, and short term follow up data. Outcome measures included operative time, en bloc resection rate, R0 resection rate, postoperative complications, Wexner score for bowel function, and follow-up results. Results    A total of 9 patients with cT2-3N0M0 rectal cancer were enrolled. All patients received capecitabine-based chemoradiotherapy. EFTR was successfully completed in all cases, with a mean operative time of 68.5 minutes. Both the en bloc resection and R0 resection rates were 100%. Postoperative pathological evaluation revealed that 6 cases had only residual mucosal lesions and 3 cases exhibited residual tumor invasion into the submucosa (ypT1). The mean postoperative Wexner score was 6.8. During a follow-up period of 11 to 36 months (median 23 months), no local recurrence, metastasis or death were observed. Conclusion    For rectal cancer patients achieving ncCR after neoadjuvant therapy, EFTR appears to be a safe and feasible treatment strategy that attains high en bloc and R0 resection rates and favorable local control during short-term follow-up. Nonetheless, further evaluation is required to determine long-term oncological outcomes.

Key words: locally advanced rectal cancer, organ preservation, endoscopic full-thickness resection, neoadjuvant chemoradiotherapy, near clinical complete response