J.Jpn. Surg. Soc.
ISSN 1880-1129

[Abstract] [Full Text HTML] [Full Text PDF] （in Japanese / 690KB） [Members Only]

J.Jpn. Surg. Soc.. 118(4): 422-427, 2017

Feature topic

ENDOSCOPIC TREATMENT FOR EARLY COLORECTAL CARCINOMA

1) Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
2) Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan

Shinji Tanaka1), Kyoku Sumimoto1), Daiki Hirano2), Yuki Ninomiya1), Yuzuru Tamaru1), Nana Hayashi1), Shiro Oka2), Kazuaki Chayama2)

Recent progress in endoscopy such as endoscopic submucosal dissection has enabled the resection of Tis/T1 colorectal carcinoma endoscopically en bloc regardless of lesion size. In this report, we review the present status of management of Tis/T1 colorectal carcinoma. Previously, only submucosal minute invasive carcinoma (within 200-300 μm) without vessel involvement and unfavorable histology could be resected. Recently, with the accumulation of many cases and detailed pathologic evaluations after complete endoscopic en bloc resection, if all the following conditions are satisfied in histological examination, curative resection can be expected: 1) submucosal invasion depth of less than 1,000 μm; 2) histologic grade of favorable; 3) no vessel involvement; and 4) budding grade of low. On the other hand, a recent study has shown that even in deep submucosal invasive carcinoma, if there are no other metastatic risk factors, the estimated risk of lymph node metastasis is around 1％. On the basis of this evidence, endoscopic treatment is gradually becoming more commonly used to achieve excisional biopsy even for cT1b colorectal carcinoma.

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