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Panel discussion: Early colorectal cancer

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Panel discussion: Early colorectal cancer

Summary

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Panel discussion explored de-escalation and organ-preserving strategies in early rectal cancer, with debate over the role of lymph node dissection and the feasibility of local excision plus chemoradiation for T2-T3 tumors.

The speaker argued that lymph node metastases in rectal cancer, like in melanoma and breast cancer, may be risk stratifiers rather than causes of distant metastasis and that removing lymph nodes might not prevent recurrence.
The TOTEM study from Spain was cited as showing local surgical excision coupled with chemoradiation is as good as surgery for T2-T3 rectal cancers, though functional outcomes and quality of life remain concerns.
The Star Trek study presented at ASCO reported 80% organ preservation in approximately 350 patients treated with neoadjuvant chemoradiotherapy followed by local excision.
A meta-analysis of 2082 T1 high-risk rectal cancer patients treated with local resection showed 5% recurrence, 3.5% distant metastasis, and 2.5% cancer-related mortality overall.
The speaker stated that all recurrences in the TEASER study were salvageable with surgery, emphasizing that success depends on timing of detection and quality of surveillance.
Panelists agreed that since survival differences between approaches may be small, future research should prioritize functional outcomes and quality of life.

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Abstract

Event

UEG Week Berlin 2025

Topics

Colorectal Digestive Oncology Endoscopy Surgery

Session

Early colorectal cancer

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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RECTAL ENDOSCOPIC KNIFE-ASSISTED FULL-THICKNESS RESECTION: FEASIBILITY AND SAFETY RESULTS FROM AN INTERNATIONAL MULTICENTER COHORT

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RECTAL ENDOSCOPIC KNIFE-ASSISTED FULL-THICKNESS RESECTION: FEASIBILITY AND SAFETY RESULTS FROM AN INTERNATIONAL MULTICENTER COHORT

Andrea Sorge 1, Maria Eva Argenziano 2, Sander C. Albers 3, Maurizio Spandre 4, Maria Laura Robone 4, Shaimaa Elkholy 5, George Tribonias 6, Alessandro Repici 7, Ludovico Alfarone 7, Sandro Sferrazza 8, Giulio Calabrese 8, Michele Montori 9, Edward J Despott 10, Elisabet Maristany Bosch 10, Lynn K. Debels 11, Pieter Jan Poortmans 12, Sultan Mahmood 13, Varun Jain 13, Mohamad A. Al-Haddad 14, Enrique Rodríguez de Santiago 15, Sanjana Bhagwat 16, Rajvinder Singh 17, Amol Bapaye 16, Simon Chu 18, Francesco Vito Mandarino 19, Paul Didden 20, Lobke Desomer 21, Leon M.G. Moons 20, Barbara A.J. Bastiaansen 22, David James Tate 23

Affiliations

1 University of Milan, Milan, Italy|||University Hospital Ghent, Ghent, Belgium

2 University of Ghent, Ghent, Belgium|||University Hospital Ghent, Ghent, Belgium

3 Amsterdam Umc, Amsterdam, Netherlands

4 ASL Città di Torino, Ospedale San Giovanni Bosco, Torino, Italy

5 Faculty of Medicine, Cairo University, Cairo, Egypt

6 Red Cross Hospital of Athens, Athens, Greece

7 Humanitas Research Hospital, Milano, Italy

8 Arnas Ospedale Civico Palermo, Palermo, Italy

9 University Hospital Ghent, Ghent, Belgium

10 Royal Free Hospital & UCL School of Medicine, London, United Kingdom

11 University Hospital of Brussels, Affligem, Belgium|||University of Ghent, Ghent, Belgium

12 University Hospital Ghent, Ghent, Belgium|||University Hospital of Brussels, Affligem, Belgium

13 University of Pittsburgh Medical Center, Pittsburgh, United States

14 Indiana University School of Medicine, Indianapolis, United States

15 Hospital Universitario Ramón y Cajal, Madrid, Spain

16 Deenanath Mangeshkar Hospital Digestive Diseases & Endoscopy, Pune, India

17 Lyell McEwin Hospital, Adelaide, Australia

18 Endoscopy Centre, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, Hong Kong

19 U.O.Gastroenterologia ed Endoscopia Digestiva Ospedale San Raffaele, Milan, Italy

20 University Medical Center Utrecht, Utrecht, Netherlands

21 AZ Delta vzw, Roeselare, Belgium|||University of Ghent, Ghent, Belgium

22 AMC Amsterdam Maag- Darm- Leverziekten, Amsterdam, Netherlands

23 University Hospital Ghent, Gent, Belgium|||University of Ghent, Ghent, Belgium

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Abstract

Introduction

Initial reports have described rectal endoscopic knife-assisted full-thickness resection (kFTR) as a novel technique for achieving R0 resection in deeply invasive or technically challenging rectal lesions, avoiding the significant morbidity and mortality of rectal surgery.^1,2 We aimed to evaluate the feasibility, safety, and technical outcomes of rectal kFTR.

Aims & Methods

In this retrospective international study, we included consecutive patients who underwent rectal kFTR at 15 centres across 4 continents between April 2017 and April 2025. We included patients with adenocarcinoma suspected of deep submucosal invasion, severe fibrosis, or subepithelial lesions were included. Primary outcomes were technical success, en-bloc and R0 resection rates and adverse events. Secondary outcomes included rectal preservation, length of hospital stay, and recurrence. Risk factors for adverse events were evaluated using univariate and multivariate logistic regression.

Results

A total of 94 patients (mean age 65 years [IQR 58-73]; 56.4% male; 79.8% ASA I/II) underwent rectal kFTR. Median lesion size was 35 mm [IQR 25-50]. kFTR was performed for suspected deep invasion (57; 60.6%), severe fibrosis (31; 33%), and subepithelial lesions (6; 6.4%). Of lesions included, 59 (62.8%) were in the distal rectum, and 13 (13.8%) were anterior.

Technical success was achieved in 92 procedures (97.9%). Mean procedure time was 135 minutes (IQR 100-180). Antibiotics were administered in 83 procedures (88.3%) for a median of 5 days (IQR 5-5). Median hospital stay was 1 day (IQR 1 - 3). Overall, 19 adverse events occurred in 15/94 (16%) patients: 12 (63.1%) mild, 6 (31.6%) moderate, and 1 (5.3%) severe per ASGE lexicon. Delayed bleeding occurred in 4 (4.3%) patients, and post-procedural pain in 7 patients (7.4%). Surgery was required in one case for a recto-vaginal fistula. Increasing lesion size was the only risk factor independently associated with a higher risk of adverse events (OR 1.05, 95% CI 1.02–1.09, p = 0.003).

En-bloc and R0 resections were achieved in 91/94 (96.8%) and 74 (78.7%) procedures, respectively. Rectal preservation was achieved in 68 patients (72.3%) while, 25 (26.6%) underwent completion surgery for non-curative cancer resections, with no residual tumor in the surgical specimen in 11/25 cases (44%).

Among 59 patients with adenocarcinoma and available follow-up (median 12 months (IQR 6 - 23.5)), 3 (5.1%) experienced loco-regional recurrences, 1 (1.7%) had distant metastasis from a pT2 adenocarcinoma with surgery after kFTR, and 1 died of non-cancer-related causes.

Anesthesia regimen, n (%) Moderate sedation/analgesia Deep sedation/analgesia General anesthesia	7 (7.4) 40 (42.6) 4 (50.0)
Defect closure, n (%) No Partial Complete	43 (45.7) 15 (16.0) 36 (38.3)
Technical success, n (%)	92 (97.9)
Adverse events, n (%) Delayed Bleeding Post-procedural pain Rectal abscess with fistulization Pelvic fascitis Recto-vaginal fistula Fever Cardio-pulmonary (anesthesia related)	4 (4.3) 7 (7.4) 1 (1.1) 1 (1.1) 1 (1.1) 2 (2.1) 3 (3.2)
En-bloc resection, n (%)	91 (96.8)
R0 resection, n (%) Global LGD/HGD pT1 sm1 pT1 sm2/3 pT2 pT3 Subepithelial lesion	74/94 (78.7) 19/22 (86.4) 2/2 (100) 24/28 (85.7) 21/31 (67.7) 0/3 (0) 8/8 (100)
Rectal preservation, n (%)	68 (72.3)
Length of hospital stay, days, median (IQR)	1 (1-3)

Table 1

Conclusion

kFTR appeared to be a feasible and safe technique for excising deeply invasive adenocarcinomas and complex fibrotic or subepithelial rectal lesions in expert centres. The high rate of R0 resections enabled accurate histopathological risk stratification, supporting individualised post-procedural management and rectal preservation in most patients. Rectal kFTR may serve as an alternative to device-assisted endoscopic full-thickness resection and local surgical excision, potentially avoiding radical surgery in highly selected patients. Further prospective research is needed to confirm these findings.

References

1. Argenziano ME*, Sorge A*, Poortmans PJ, Montori M, Balducci D, Hoorens A, Maroni L, Tate DJ, Knife-Assisted Full-Thickness Resection Guided by Pocket Detection Method for Detection and Complete Excision of Deeply Invasive Rectal Cancer, VideoGIE (2024), doi: https://doi.org/10.1016/j.vgie.2024.11.004.
2. Argenziano, M.E.*, Sorge, A.*, Hoorens, A., Montori, M., Poortmans, P.J., Smeets, S., Tornai, T., Debels, L.K., Desomer, L. and Tate, D.J. (2025), Knife-assisted full-thickness resection guided by the pocket-detection method for posterior deeply invasive rectal cancer: A novel endoscopic approach (with video). DEN Open, 5: e70116. https://doi.org/10.1002/deo2.70116

Event

UEG Week Berlin 2025

Topics

Colorectal Digestive Oncology Endoscopy

Submission format

Abstract

Session

It's all about the right technique: Colorectal lesions

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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UEG Presentation

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Immunotherapy in colorectal cancer: Where are we now?

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Immunotherapy in colorectal cancer: Where are we now?

Markus Jördens 1, Christoph Roderburg 2

Affiliations

1 University Hospital Düsseldorf, Düsseldorf, Germany

2 University Hospital of Düsseldorf, Düsseldorf, Germany

Summary

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Abstract

Event

UEG Postgraduate Teaching Programme Berlin 2025

Topics

Digestive Oncology Immunology Mechanisms & Personalised Medicine

Session

Immunotherapy in digestive cancers: Where are we heading?

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Spotted! In front of an LST– describing, reporting, thinking ahead

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Spotted! In front of an LST– describing, reporting, thinking ahead

Naoya Toyoshima 1

Affiliations

1 Showa University Nothern Yokohama Hospital Digestive Disease Center, Yokohama, Japan

Summary

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Abstract

Event

UEG Postgraduate Teaching Programme Berlin 2025

Topics

Colorectal Digestive Oncology Surgery

Session

The ultimate guide to colorectal cancer staging surgery adjuvant treatment

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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UEG Presentation

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Not sure what you can access? Learn more about account types.

Progression risk, chemoprevention and surveillance strategies

Massimiliano di Pietro 1

Affiliations

1 University of Cambridge, Cambridge, United Kingdom

Summary

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Abstract

Event

UEG Postgraduate Teaching Programme Berlin 2025

Topics

Digestive Oncology Endoscopy Oesophagus

Session

Best of Barrett’s oesophagus

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

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Panel discussion: Best of Barrett’s oesophagus

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

Panel discussion: Best of Barrett’s oesophagus

Summary

AI Generated

Summary is not available for this content yet.

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Abstract

Event

UEG Postgraduate Teaching Programme Berlin 2025

Topics

Digestive Oncology Endoscopy Oesophagus

Session

Best of Barrett’s oesophagus

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Marietta Iacucci

UEG Presentation

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Detection and management of dysplasia in UC

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

Detection and management of dysplasia in UC

Marietta Iacucci 1

Affiliations

1 University College Cork, Cork, Ireland

Summary

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Abstract

Event

UEG Postgraduate Teaching Programme Berlin 2025

Topics

Digestive Oncology IBD

Session

Cancer and IBD: Mitigating risk among uncertainty

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Christoph Roderburg

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Marietta Iacucci

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