Endoscopic Diagnosis And Treatment For Early Colorectal Carcinomas- Advancements And Challenges | 34271
Journal of Gastrointestinal & Digestive System
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Since recent advancement of endoscopic therapeutic technology, the numbers of endoscopic resection for early colorectal carcinomas
with little risk of lymph node metastasis is increasing. There have been no reports of lymph node metastasis in intramucosal (Tis)
carcinomas, while lymph node metastasis occurs in 6.8–17.8 % of submucosal (T1) carcinomas. Three clinical guidelines have been
published in Japan and the strategy of the management for early colorectal tumors is demonstrated. According to 2014 JSCCR
Guidelines for the Treatment of Colorectal Cancer, among endoscopically treated carcinomas, T1 carcinoma with a histologically
diagnosed as a positive vertical margin should be performed additional surgery. Additional surgery may be considered when at least
one of the following histological findings is detected: i) SM invasion depth ≥1,000 μm; ii) histological type of por., sig., or muc.; iii)
budding grade 2-3; and iv) positive vascular permeation. While resected lesion is histologically diagnosed as a T1 carcinoma without
any histological findings mentioned above, it could be followed up without additional surgery. In order to accomplish complete
endoscopic resection with both vertical and horizontal margin negative, ESD is a reliable technique for en block resection regardless
of lesions size compared with conventional EMR. It has been discussed about the possibility of the endoscopic total excisional biopsy
for T1b carcinomas using NBI or EUS. As for the prognosis of endoscopically resected T1 carcinomas, relapse ratio is relatively low
as about 3.4% (44/1,312), but prognosis was poor as 72 of cancer death out of 134 relapsed cases (54%) once relapse has occurred.
It is expected that more detailed stratification of lymph node metastasis risk after endoscopic resection for T1 carcinomas and
the prognosis of relapsed cases in a prospective fashion will become apparent, and appropriate indication of endoscopic resection
including total incision biopsy for T1 carcinomas will be established.
Yusuke Saitoh completed his MD and PhD from Asahikawa Medical University, Asahikawa, Japan. He stayed in Texas, USA and did research on flat and depressed type colorectal tumors. He has received many honors and awards. He is a distinguished Director at Asahikawa City Hospital and clinical Professor in Asahikawa Medical University. He is also a manager of the Hokkaido prefecture branch of Japan Gastroenterological Endoscopy and Editorial Board Member of Stomach and Intestine (traditional Japanese Journal in regard to gastrointestinal diagnostic and therapeutic endoscopy). He has been invited from 13 countries and performed more than 30 lectures and live demonstrations so far.