title: Controversies on the treatment strategy for rectal submucosal cancer: case series and review of the literature.
abstract: Endoscopic submucosal dissection (SD) has emerged as one of the treatment strategies for submucosal rectal cancers. The present study reviewed the clinical outcomes of patients with rectal submucosal cancer treated by ESD. This was a retrospective review of four patients who had rectal tumor treated by ESD from 2010 to 2012 with histopathology showing T1 submucosal adenocarcinoma. The mean age (SD) was 69.5 (7.33) and the male to female ratio was 3:1. There were no post-ESD complications. The mean (SD) size of the tumors was 2.93 (0.87) cm. One patient with deep resection margin involvement received laparoscopic low anterior resection. Another with deep margin involvement of <1 mm refused surgery and was treated by chemoradiotherapy.There was no recurrence in all the cases with a mean follow-up duration of 461.3 (209.0) days. ESD was one of the important treatment strategies for T1sm-s rectal cancer especially when the risk of nodal metastasis was low. ESD spared the patient from colostomy when the T1 cancer was located in the lower third of the rectum. The role of adjuvant and neoadjuvant chemoradiotherapy remains controversial.
authors.affiliation: Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Shannon Melissa
authors.initials: SM
authors.lastname: Chan
authors.forename: Philip Wai Yan
authors.initials: PW
authors.lastname: Chiu
authors.forename: Sok Fei
authors.initials: SF
authors.lastname: Hon
authors.forename: Anthony Wing Ip
authors.initials: AW
authors.lastname: Lo
authors.forename: Simon Siu Man
authors.initials: SS
authors.lastname: Ng
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000601:surgery*; D000368:Aged; D003113:Colonoscopy / Q000379:methods*; D004210:Dissection / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome