Combination of endoscopic submucosal dissection and transanal excision for the local excision of distal rectal cancer with deep submucosal invasion

Radical surgery with preoperative or postoperative chemoradiation is regarded as the standard treatment for locally advanced rectal cancer. However, despite the risk of recurrence, local excision after preoperative chemoradiation is another therapeutic option, especially in patients who are not candidates for radical surgery because of underlying medical conditions or who refuse radical surgery to avoid colostomy. Endoscopic submucosal dissection (ESD) and transanal excision (TAE) represent two options for the local excision of rectal lesions, each with its own advantages and disadvantages. For example, ESD is suitable for a broader and more superficial rectal neoplasia, whereas TAE is suitable for a relatively small and deeper rectal lesion. Here we describe the successful treatment and preservation of anorectal function of a patient by sequential ESD and TAE after neoadjuvant chemoradiation therapy for a locally advanced rectal cancer comprising central deep submucosal and peripheral broad superficial components.