Endoscopic (EID) Versus Surgical (TAMIS) Local Excision for Early Stage Rectal Cancer

Prior treatment

• Prior endoscopic or surgical resection attempts of the tumour.
• Recurrent cancer after previous surgical or endoscopic local resection.
• Inflammatory bowel disease (IBD) with previous inflammation of the rectum.
• Previous pelvic irradiation or neoadjuvant therapy.
• Concomitant malignancies or other severe medical conditions that, in the opinion of the multidisciplinary team (MDT), are likely to result in death within 5 years.

Other

• A patient who meets one or more of the following criteria will be excluded from participation in this study:
• Lesions involving more than 50% of the circumference.
• Total lesion size larger than 6 cm.
• Severe pre-existing faecal incontinence with impaired quality of life.
• Poor general health that prevents the use of general anaesthesia.
• Inability or contraindication to undergo MRI scan.
• AJCC stage II, III or IV CRC within the last 5 years or synchronous CRC.
• Inability to complete questionnaires or sign informed consent.
• Known pregnancy.

• To be eligible to participate in this study, a patient must meet all of the following criteria:
• Adult patients (≥ 18 years of age).
• Suspected rectal D-SMIC based on optical diagnosis using narrow-band imaging:
• Hiroshima C2/3, JNET 3, NICE III, Kudo Vn pit pattern.
• The presence of non-lifting together with features of superficial submucosal invasion (Hiroshima C1, JNET 2B, Kudo Vi pit pattern).
• MRI shows cT1-T2 invasion and minimum of 1 mm preserved muscularis propria.
• Tumour with its lower border situated on or below the level of the sigmoid take off as shown on rectal MRI.
• Staging rectal MRI confirms absence of suspicious malignant mesorectal lymph nodes, defined as mucinous lymph nodes, perirectal lymph nodes \>9 mm in short-axis diameter, or ≥7 mm for lateral lymph nodes (classified as certain cN+), or 5-9 mm peri-rectal lymph nodes with at least 2 suspect morphological features: round shape, heterogeneity and/or irregular borders (classified as doubtful cN+).
• Staging rectal MRI confirms absence of tumour deposits.
• Staging rectal MRI confirms absence of extramural vascular invasion (EMVI).