QS133 - Expanding Organ Preservation in Locally Advanced Rectal Cancer After Total Neoadjuvant Therapy with Endoscopic Submucosal Dissection (ESD)

Sunday, May 11, 2025

4:05 PM – 4:09 PM PT

Location: Room 9, Upper Level

Quick Shot Presenter(s)

Kamil Erozkan, MD

Research Fellow
University Hospitals Cleveland Medical Center, Department of Surgery, Division of Colorectal
Cleveland, OH, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

JS

Josh Sommovilla, MD

Assistant Professor of Surgery
Cleveland Clinic
Cleveland, Ohio, United States

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Ali Alipouriani, MD

Clinical Research Fellow
Colorectal Surgery Department, Digestive Disease Institute, Cleveland Clinic Foundation
Department of colorectal surgery, Cleveland Clinic Foundation
Cleveland, Ohio, United States

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This individual has no financial relationships with ineligible companies.
Metincan ERKAYA, MD (he/him/his)

Research Trainee
Colorectal Surgery Department, Cleveland Clinic Foundation- Main Campus
Cleveland Clinic
Cleveland, Ohio, United States

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This individual has no financial relationships with ineligible companies.
Tracy L. Hull, n/a

Emeritus Professor
Cleveland Clinic
Cleveland Clinic Foundation, Lerner School of Medicine of Case Western University
Chagrin Falls, Ohio, United States

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This individual has no relevant relationships with ineligible companies.
David Liska, MD

Associate Professor, Chair
Department of Colorectal Surgery, Cleveland Clinic
Cleveland Clinic, Cleveland, Ohio
Cleveland, Ohio, United States

Disclosure information not submitted.
Scott R. Steele, MD, MBA

President, Cleveland Clinic, Main Campus Submarket and Rupert B. Turnbull M.D., Endowed Chair in Colorectal Surgery
Cleveland Clinic
Cleveland, OH, United States

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This individual has no financial relationships with ineligible companies.
EG

Emre Gorgun, MD, MBA

Vice Chair, Department of Colorectal Surgery
Cleveland Clinic Foundation-Main Campus
Cleveland, Ohio, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no relevant relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Kamil Erozkan, MD: This individual has no financial relationships with ineligible companies.

Josh Sommovilla, MD: This individual has no financial relationships with ineligible companies.

Ali Alipouriani, MD: This individual has no financial relationships with ineligible companies.

Metincan ERKAYA, MD: This individual has no financial relationships with ineligible companies.

Tracy L. Hull, n/a: This individual has no relevant relationships with ineligible companies.

Scott R. Steele, MD, MBA: This individual has no financial relationships with ineligible companies.

Emre Gorgun, MD, MBA: This individual has no relevant relationships with ineligible companies.

Image or Table (Do Not add text here): Table 1: Histopathology results and ESD outcomes

Purpose/Background: In the current management of locally advanced rectal cancer, organ preservation following total neoadjuvant therapy (TNT) obliges complete clinical response (cCR) and close surveillance. Typically, patients with near complete response (nearCR) and/or tumor regrowth during watch and wait (WW) are recommended to undergo total mesorectal excision (TME). For patients who exhibit near-CR or regrowth, the selective use of local resection procedures, such as endoscopic submucosal dissection (ESD), may be a potential approach to extend organ preservation.

Methods/Interventions: Patients who were recommended TNT between 2015 and 2024 were reviewed retrospectively. The study included patients who underwent ESD either near complete response or tumor regrowth during active surveillance. Demographics, tumor characteristics, treatment methods, and follow-up data were reported. Primary outcome was organ preservation and regrowth rates after ESD.

Results/Outcomes: The study included 16 patients, of whom 7 were female (43%). The median age was 52 years (IQR 17.8). While 9 patients underwent ESD for near-CR with endoluminal lesions following TNT completion, 7 underwent ESD due to tumor regrowth during WW. The median time for tumor regrowth was 15 months. Pathologic results following ESD showed no evidence of invasive cancer in 12 patients (75%). TME was performed in three patients due to the invasive adenocarcinoma found on ESD. The other patient refused proctectomy. One patient with dysplasia following an additional WW period after ESD, underwent TME due to second regrowth. Twelve patients including one who refused surgery are closely monitored to date with no evidence of disease for a median of 19 months (Table 1).

Conclusion/Discussion: In the management of rectal cancer following TNT, selective use of ESD is feasible and safe with promising short-term results. ESD may expand the use of organ preservation in this highly select population as a reliable marker by tissue sampling. Larger prospective trials with longer follow-ups are needed to validate its value.