ArticleFrontiers in oncology2026
Efficacy and safety of endoscopic submucosal dissection for rectal tumors with or without dentate line involvement: a propensity score matching analysis.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To evaluate the technical feasibility, safety, and therapeutic outcomes of endoscopic submucosal dissection (ESD) for rectal tumors extending to the dentate line (RTDLs) compared with non-RTDLs using propensity score matching (PSM). Methods: We retrospectively reviewed 127 patients with rectal tumors treated with ESD at two tertiary centers from November 2012 to December 2023 (51 RTDLs, 76 non-RTDLs). A 1:1 PSM based on age, sex, and lesion diameter yielded 51 matched pairs (102 patients in total). Procedural parameters, pathological outcomes (classified as low-grade dysplasia (LGD), high-grade dysplasia (HGD), and adenocarcinoma), postoperative complications, and long-term oncological outcomes were systematically analyzed. Results: Following 1:1 PSM, baseline characteristics were well balanced between the non-RTDLs and RTDLs groups (P>0.05). En bloc resection was achieved in 100.0% of cases in both groups. R0 resection rates were comparable between the non-RTDLs and RTDLs groups (98.04% vs. 96.08%, P>0.999). However, the RTDLs group required a significantly longer mean ESD procedure duration (99.3 ± 72.8 min vs. 56.0 ± 52.9 min, P = 0.002) and demonstrated lower dissection speed (5.7 ± 6.5 min/cm Conclusion: ESD is a safe and effective organ-preserving treatment for rectal tumors extending to the dentate line, achieving excellent en bloc and R0 resection rates comparable to non-RTDLs. However, RTDLs present substantial technical complexity, resulting in longer procedure times, lower dissection efficiency, and increased risk of postoperative anal pain. Careful preoperative planning, endoscopist expertise, and close postoperative surveillance are essential when managing RTDLs.
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