Seretis F, Panagaki A, Gkolfakis P, Tziatzios G, Paraskeva K. Endoscopic assessment of rectal cancer response after neoadjuvant chemoradiotherapy: A narrative literature review. World J Clin Oncol 2025; 16(11): 106498 [DOI: 10.5306/wjco.v16.i11.106498]
Corresponding Author of This Article
Georgios Tziatzios, MD, PhD, Department of Gastroenterology, General Hospital of Nea Ionia “Konstantopoulio-Patision”, Theodore Konstantopoulou 3-5, Nea Ionia, Athens 14233, Attiki, Greece. g_tziatzios@yahoo.gr
Research Domain of This Article
Gastroenterology & Hepatology
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Systematic Reviews
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nov 24, 2025 (publication date) through Nov 21, 2025
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Publication Name
World Journal of Clinical Oncology
ISSN
2218-4333
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Seretis F, Panagaki A, Gkolfakis P, Tziatzios G, Paraskeva K. Endoscopic assessment of rectal cancer response after neoadjuvant chemoradiotherapy: A narrative literature review. World J Clin Oncol 2025; 16(11): 106498 [DOI: 10.5306/wjco.v16.i11.106498]
Fotios Seretis, First Propaedeutic Department of Surgery, Hippokrateion General Hospital of Athens, Athens 15124, Attiki, Greece
Antonia Panagaki, Paraskevas Gkolfakis, Georgios Tziatzios, Konstantina Paraskeva, Department of Gastroenterology, General Hospital of Nea Ionia “Konstantopoulio-Patision”, Athens 14233, Attiki, Greece
Co-corresponding authors: Paraskevas Gkolfakis and Georgios Tziatzios.
Author contributions: Seretis F wrote the manuscript and prepared figures and tables; Panagaki A, Gkolfakis P, Tziatzios G, and Paraskeva K performed data acquisition and writing; All authors read and approved the final version of the manuscript to be published. Co-corresponding authors have equally contributed in conceiving the manuscript idea; reviewed the literature and drafted the manuscript.
Conflict-of-interest statement: The authors declare no conflicts of interest associated with this manuscript.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Georgios Tziatzios, MD, PhD, Department of Gastroenterology, General Hospital of Nea Ionia “Konstantopoulio-Patision”, Theodore Konstantopoulou 3-5, Nea Ionia, Athens 14233, Attiki, Greece. g_tziatzios@yahoo.gr
Received: February 28, 2025 Revised: June 17, 2025 Accepted: October 11, 2025 Published online: November 24, 2025 Processing time: 266 Days and 23.3 Hours
Abstract
BACKGROUND
Rectal cancer management is currently evolving with the advent of different neoadjuvant treatment strategies and organ preservation strategies. A significant proportion of patients could achieve complete clinical response after neoadjuvant treatment, which often translates to pathologic complete response (pCR) as assessed on surgical specimens after curative intent surgery. Endoscopy plays a significant role in assessing treatment response to neoadjuvant therapies.
AIM
To explore the role of endoscopy in predicting subsequent pCR after neoadjuvant treatment in rectal cancer patients.
METHODS
An extensive literature review was undertaken to identify the criteria used for assessment of endoscopic response and their ability to predict pCR.
RESULTS
Fifteen studies were identified through literature review. The most commonly used endoscopic criteria for evaluation included the presence of a flat white scar and the absence of nodularity or telangiectasia. Information on the timing of endoscopic assessment in relation to neoadjuvant treatment protocols were also extracted from the studies. In most studies, the diagnostic accuracy for predicting pCR exceeded 0.8. The main limitations identified were the retrospective design of included studies included and a moderate risk of bias.
CONCLUSION
Endoscopy can be a key prognostic factor in predicting pCR to neoadjuvant treatment in rectal cancer despite significant limitations in currently available data.
Core Tip: Endoscopic assessment of rectal cancer response after neoadjuvant treatment can accurately predict pathologic complete response when specific criteria are applied. The combination of endoscopic features, including the absence of nodularity and ulceration, and the presence of a flat white scar with telangiectasia, achieves a diagnostic accuracy exceeding 80% for predicting pathologic complete response before curative intent surgery. These findings support the use of endoscopic evaluation as a reliable tool to guide safe omission of surgery in organ-preservation strategies.
