Endoscopic mesorectal dissection for precise rectal cancer staging: trespassing the boundaries of lumenal rectal interventions

Total mesorectal excision (TME) has been the primary treatment for patients with locally advanced rectal cancer (LARC). Still, it is associated with significant urinary, defecatory, and sexual dysfunction and a permanent stoma.1 Surgical local excision in the form of transanal excision or transanal endoscopic microsurgery is widely performed for the treatment of T1 lesions2 and, more recently, as adjuvant therapy for LARC.3 Recent multicenter randomized controlled trials demonstrated that surgical local excision showed similar oncologic results to TME for T2-T3 cancer after neoadjuvant chemoradiotherapy.