Abstract
PURPOSE: The purpose of this study was the evaluation of various factors in the formulation of guidelines for treatment of early invasive colorectal cancer, in which malignant cells extend through the muscularis mucosa into the submucosa but do not deeply invade the muscularis propria. METHOD: A total of 182 patients were followed for at least five years or until death, with early invasive cancer diagnosed between 1982 and 1989. Patients were grouped according to the level of invasion, as follows: 64 patients with slight carcinoma invasion of the muscularis mucosa (200–300 (μm;sm1), 82 with intermediate invasion (sm2), and 36 with carcinoma invasion extending to the inner surface of the muscularis propria (sm3). RESULT: The configuration, diameter, and histologic grade of adenocarcinoma and lymphovascular invasion were correlated with level of invasion. After endoscopic polypectomy or local resection, 4 patients showed local recurrence and 13 patients showed lymph node metastasis. None of these 17 patients had sml disease. The level of invasion, configuration, and location were significant risk factors for development of lymph node metastasis or local recurrence (P<0.05), but lymphovascular invasion, histologic grade, and diameter were not risk factors. CONCLUSIONS: Preoperative assessment of the level of invasion using this classification, in which the submucosa is divided into three depths, may decrease the incidence of unnecessary surgery for sessile polyps. Assessment according to the level of invasion is useful in the formulation of appropriate guidelines for the treatment of early invasive cancer.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Kudo S. Endoscopic mucosal resection of flat and depressed types of early colorectal cancer. Endoscopy 1993;25:455–61.
Tada M, Shimizu S, Nomiyama S,et al. Preliminary report on a new endoscopic therapy of colorectal cancer and polyp. J Kyoto Pref Univ Med 1988;97:355–60.
Sakatani A, Koizumi K, Maruyama M,et al. Diagnosis of sm cancer of the large intestine—with special reference to its x-ray diagnosis. Stomach and Intestine 1991;26:726–35.
Japanese Research Society for Cancer of Colon and Rectum. General rules for clinical and pathological studies on cancer of colon, rectum and anus. 4th ed. Tokyo: Kinbara Shuppan, 1985.
Colacchio TA, Forde KA, Scantlebury VP. Endoscopic polypectomy—inadequate treatment for invasive colorectal carcinoma. Ann Surg 1981;194:704–7.
Langer JG, Cohen Z, Taylor BR, Stafford S, Jeejeebhoy KN, Cullen JB. Management of patients with polyps containing malignancy removed by colonoscopic polypectomy. Dis Colon Rectum 1984;27:6–9.
Morson BC, Whiteway JE, Jones EA. Histopathology and prognosis of malignant colorectal polyps treated by endoscopic polypectomy. Gut 1984;25:437–44.
Nivatvongs S, Rojanasakul A, Reiman HM,et al. The risk of lymph node metastasis in colorectal polyps with invasive adenocarcinoma. Dis Colon Rectum 1991;34:323–8.
Haggitt RC, Glotzbach RE, Soffer EE, Wruble LD. Prognostic factors in colorectal carcinomas arising in adenomatous implications for lesions removed by endoscopic polypectomy. Gastroenterology 1985;89:328–36.
Christie JP. Malignant colon polyp—cure by colonoscopy or colectomy? Am J Gastroenterol 1984;79:543–7.
Rossini FP, Ferrari A, Coverlizza S,et al. Large bowel adenomas containing carcinoma—a diagnostic and therapeutic approach. Int J Colorectal Dis 1988;3:47–52.
Wolff WI, Shinya H. Definitive treatment of “malignant” polyps of the colon. Ann Surg 1975;182:5l6–25.
Coutsoftides T, Sivak MV Jr, Benjamin SP, Jagelman D. Colonoscopy and the management of polyps containing invasive carcinoma. Ann Surg 1978;188:638–41.
Nivatvongs S, Goldberg SM. Management of patients who have polyps containing invasive carcinoma removed via colonoscope. Dis Colon Rectum 1978;21:8–11.
Webb WA, McDaniel L, Jones L. Experience with 1000 colonoscopic polypectomies. Ann Surg 1985;201:626–32.
Cooper HS. Surgical pathology of endoscopically removed malignant polyps of the colon and rectum. Am J Surg Pathol 1983;7:613–23.
Bartnik W, Butruk E, Orlowska J. A conservative approach to adenomas containing invasive carcinoma removed colonoscopically. Dis Colon Rectum 1985;28:673–5.
Cranley JP, Petras RE, Carey WD, Paradis K, Sivak MV. When is endoscopic polypectomy adequate therapy for colonic polyps containing invasive carcinoma? Gastroenterology 1986;91:419–27.
Fried GM, Hreno A, Duguid WP, Hampson LG. Rational management of malignant colon polyps based on long-term follow up. Surgery 1984;96:815–22.
Christie JP. Polypectomy or colotomy? Management of 106 consecutively encountered colorectal polyps. Am Surg 1988;54:93–99.
DeCosse JJ. Malignant colorectal polyp. Gut 1984;25:433–6.
Shatney CH, Lober PH, Gilbertsen VA, Sosin H. The treatment of pedunculated adenomatous colorectal polyps with focal cancer. Surg Gynecol Obstet 1974;139:845–50.
Hermanek P, Gall FP. Early (microinvasive) colorectal carcinoma, pathology, diagnosis, surgical treatment. Int J Colorectal Dis 1986;1:79–84.
Pollard CW, Nivatvongs S, Rojanasakul A, Reiman HM, Dozois RR. The fate of patients following polypectomy alone for polyps containing invasive carcinoma. Dis Colon Rectum 1992;35:933–7.
Cooper HS. Surgical pathology of endoscopically removed malignant polyps of the colon and rectum. Am J Surg Pathol 1983;7:613–23.
Author information
Authors and Affiliations
About this article
Cite this article
Kikuchi, R., Takano, M., Takagi, K. et al. Management of early invasive colorectal cancer. Dis Colon Rectum 38, 1286–1295 (1995). https://doi.org/10.1007/BF02049154
Issue Date:
DOI: https://doi.org/10.1007/BF02049154