Focal endoscopic intermuscular dissection guided by the pocket-detection method for radical excision of early T2 rectal cancer

An 80-year-old man presenting hematochezia was referred to our institution due to a 20 mm slightly elevated rectal lesion with a central depression (Paris 0–IIa+c) on the right-posterior rectal wall below the inferior Houstonʼs valve ([Video 1]). The macroscopic appearance and virtual chromoendoscopy (JNET III surface and vascular pattern) suggested a deeply invasive cancer ([Fig. 1]). Staging pelvic magnetic resonance imaging revealed rectal cancer with invasion but partial preservation of the muscularis propria (T1b/early T2) without malignant lymph nodes or extramural vascular invasion. A total body computer tomography (CT) scan did not reveal distant metastases. After a multidisciplinary team discussion, the patient refused total mesorectal excision, and an endoscopic local excision was then offered.