ESD achieves R0 resection for large rectal intramucosal carcinoma involving dentate line in case report
A case report describes a 70-year-old male patient with a 2-year history of altered bowel habits who underwent endoscopic submucosal dissection (ESD) for a large rectal tumor extending to the dentate line and associated with a diverticulum. No comparator was reported. The procedure was completed successfully, and the diverticulum was managed without complications. Postoperative histological analysis confirmed a conventional serrated adenoma with high-grade intraepithelial neoplasia and focal intramucosal carcinoma (pTis), with R0 resection margins and no lymphovascular invasion.
At the 1-year postoperative follow-up, there was no evidence of tumor recurrence or distant metastasis, and anal function was preserved. The report notes the procedure was managed without complications, though specific data on serious adverse events, discontinuations, or tolerability were not reported.
Key limitations include that this is a single case report, and the authors note that larger cohort studies with long-term follow-up are required to validate generalizable safety and efficacy. The funding source and potential conflicts of interest were not reported.
In practice, this case demonstrates the technical feasibility and potential curative effect of ESD for a complex rectal lesion involving the dentate line. However, clinicians should recognize this as very low certainty evidence from a single patient. The findings cannot support generalizable conclusions about safety, efficacy, or long-term outcomes, and the approach requires validation in controlled studies.
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