Advanced Rectal Cancer: Achieving Radical Cure and Organ Preservation via MDT and Endoscopic Precision
[Introduction: The Dilemma of Modern Proctology]
In the treatment of advanced rectal cancer, surgeons and patients often face a harrowing choice: "Life vs. Quality of Life." When a tumor is located near the anal sphincter, traditional radical surgery often necessitates the removal of the anus, leading to a permanent colostomy—a life-altering outcome for the patient. At Beijing Friendship Hospital, we are rewriting this narrative through Multidisciplinary Team (MDT) collaboration and cutting-edge endoscopic technology.
[Clinical Case: A Crisis at 5cm]
Recently, a 56-year-old male patient was diagnosed with a 2.0cm ulcerated adenocarcinoma located just 5cm from the anal margin. The lesion was classified as advanced, with deep infiltration and a "crater-like" appearance. Given its proximity to the sphincter, the case presented a high risk of permanent functional loss if treated with conventional surgery.
[Phase I: Strategic Steering by Professor Zhang Shutian]
Under the guidance of Professor Zhang Shutian, a world-renowned gastroenterologist and Director of the National Clinical Research Center for Digestive Diseases, the hospital initiated an MDT consultation. Professor Zhang anchored the strategy: "Preoperative Neoadjuvant Chemoradiotherapy + Radical Endoscopic Resection." This path was designed to "downstage" the tumor first, minimizing surgical trauma and maximizing the possibility of organ preservation.
[Phase II: Sub-millimeter Precision in Downstaging]
The radiotherapy team, led by Professor Liu Ningbo, implemented a tailored "Dual-Modal Fusion Precision Radiotherapy" plan. By delivering 25 sessions of sub-millimeter targeted radiation combined with oral chemotherapy, the team successfully reduced the tumor's size from 2.0cm to 1.5cm. Most importantly, the infiltration depth was significantly shallowed, and surrounding edema was controlled, clearing the path for a minimally invasive intervention.
[Phase III: The "Micro-Carving" Endoscopic Mastery]
The final, critical phase was executed by Professor Li Peng, Vice President of Beijing Friendship Hospital and a leading expert in digestive endoscopy.
Performing an endoscopic resection after radiotherapy is notoriously difficult due to tissue fibrosis and increased vascularity. During the 80-minute procedure, Professor Li utilized a "micro-carving" technique. Despite the lack of a clear submucosal "lift" due to adhesion, he successfully navigated the narrow pelvic space, avoiding the sphincter nerves and blood vessels. The tumor was removed via Endoscopic Full-thickness Resection (EFTR) with less than 10ml of blood loss. The wound was then meticulously sealed using a specialized purse-string suture technique.
[Result: Radical Cure with Dignity]
The post-operative pathology confirmed an R0 resection—meaning no cancer cells were found at the margins. The patient recovered rapidly, regaining normal bowel function without the need for a stoma.
[Conclusion: Setting the Benchmark]
This success story is a testament to Beijing Friendship Hospital’s commitment to "Expert-Led, Technology-Driven" care. By closing the loop between radiotherapy and endoscopy, we continue to set new international benchmarks for digestive disease treatment, offering hope and a high quality of life to cancer patients worldwide.
