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Review
. 2022 Feb 14;14(4):948.
doi: 10.3390/cancers14040948.

Minimally Invasive Endoscopic and Surgical Management of Rectal Neoplasia

Sarah S Al Ghamdi  1 , Ira Leeds  2 , Sandy Fang  3 , Saowanee Ngamruengphong  4
Affiliations
Review

Minimally Invasive Endoscopic and Surgical Management of Rectal Neoplasia

Sarah S Al Ghamdi et al. Cancers (Basel). .

Abstract

Rectal cancer demonstrates a characteristic natural history in which benign rectal neoplasia precedes malignancy. The worldwide burden of rectal cancer is significant, with rectal cancer accounting for one-third of colorectal cancer cases annually. The importance of early detection and successful management is essential in decreasing its clinical burden. Minimally invasive treatment of rectal neoplasia has evolved over the past several decades, which has led to reduced local recurrence rates and improved survival outcomes. The approach to diagnosis, staging, and selection of appropriate treatment modalities is a multidisciplinary effort combining interventional endoscopy, surgery, and radiology tools. This review examines the currently available minimally invasive endoscopic and surgical management options of rectal neoplasia.

Keywords: adenoma; cancer; endoscopic resection; minimally invasive; neoplasia; polyp; rectum; submucosal invasion; surgery.

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Conflict of interest statement

S.N: consultant for Boston Scientific and received research support from Magentiq Eye LTC. All authors declare they have no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Algorithm for approach to rectal polyp assessment and management.
Figure 2
Figure 2
NBI International Colorectal Endoscopic (NICE) and (WASP) classifications for distinguishing between hyperplastic and adenomatous polyps.
Figure 3
Figure 3
Classification of laterally spreading tumors. (a) Homogeneous granular laterally spreading tumor (LST-G); (b) nodular mixed type granular laterally spreading tumor (LST-MG); (c) flat nongranular laterally spreading tumor (LST-NG); (d) pseudodepressed nongranular laterally spreading tumor.
Figure 4
Figure 4
Cold EMR of sessile serrated ascending colon polyp: (a) Sessile serrated polyp in ascending colon following submucosal injection; (b,c) piecemeal resection with cold snare, taking into consideration adequate overlap of resection pieces and clear margins; (d) post-resection mucosal defect.
Figure 5
Figure 5
ESD of rectal polyp: (a) Rectal polyp seen in retroflexion; (b) mucosal injection with viscous solution and methylene blue; (c) mucosal incision using DualKnife J; (d) submucosal dissection; (e) resection site defect; (f) final 3 cm Paris classification Isp + IIa LST-mixed granular type.
See this image and copyright information in PMC

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