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.
Study Type
OBSERVATIONAL
Enrollment
300
Endoscopic 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 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.
Jagiellonian University in Krakow
Krakow, Poland
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
Time frame: During the procedure
Intraprocedural perforation rate
A 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.
Time frame: During the procedure
Delayed bleeding rate
A symptomatic bleeding including hematemesis, melena, or a hemoglobin decrease of more than 2 g/dL.
Time frame: Within 28 days after the procedure
Delayed perforation rate
Clinical signs of peritonitis accompanied by radiological evidence of free intraperitoneal air.
Time frame: Within 14 days after the procedure
Post-coagulation syndrome rate
The occurrence of localized abdominal pain or peritoneal irritation signs after EID, accompanied by inflammatory response (elevated white blood cell count or C-reactive protein), in the absence of radiological or endoscopic evidence of perforation.
Time frame: Within 28 days following the procedure
The need for emergency interventions
Any unplanned therapeutic intervention related to the index procedure during hospitalization or follow-up, including repeat endoscopy, endoscopic or radiological intervention, blood transfusion, or surgical treatment. Planned surveillance procedures were not considered additional interventions.
Time frame: Within 30 days after the procedure
Procedure-related mortality rate
Number of deaths occurring within 30 days of the index procedure that was directly attributable to the procedure or to procedure-related complications. Deaths unrelated to the procedure were reported but not considered procedure-related mortality.
Time frame: Within 30 days after the procedure
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.
Time frame: Intraprocedural
Complete resection rate
The rate of lesions resected completely according to the pathological examination of the resected specimen.
Time frame: Within 30 days after the procedure
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.
Time frame: Intraprocedural
Length of hospital stay
The number of days from the day of the procedure (day 0) to the day of hospital discharge.
Time frame: Withing 30 days after the procedure
The need for additional treatment
The number of patients who required completion surgery or adjuwant (chemo)radiotherapy.
Time frame: Within a year after the procedure
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