Does prior endoscopic intramuscular dissection for rectal cancer increase the risk of permanent stoma in patients requiring completion total mesorectal excision?

Van der Schee et al 1 recently reported favourable 3-year oncological outcomes following endoscopic intramuscular dissection (EID). Patients with suspected rectal deep submucosal invasive cT1N0 or cT2N0 cancer were eligible for the study. The authors suggested that EID is a safe alternative to primary total mesorectal excision (TME) in such cases. Notably, of the 177 patients, 53 (30%) underwent completion TME and 16 (9%) received adjuvant chemoradiotherapy due to high-risk histopathological features identified in the EID specimen. Thus, before EID can be widely recommended, its potential adverse impact on subsequent completion TME is worth evaluating.