Abstract
PURPOSE: This study was undertaken to clarify the indications for endoscopic treatment. METHODS: Clinical and pathologic features of 191 lesions in 180 patients with early rectal carcinoma were examined, including 110 intramucosal carcinomas and 81 carcinomas with submucosal invasion (submucosal carcinomas). All lesions had been endoscopically or surgically resected at the National Cancer Center Hospital between 1976 and 1990. RESULTS: Metastasis to regional lymph nodes (LN metastasis) was seen in 0 percent (0/39) of intramucosal carcinomas and 9.2 percent (6/65) of submucosal carcinomas in the surgically treated patients. The incidence of LN metastasis was higher for lesions larger than 10 mm in diameter, for those showing massive submucosal invasion, and for moderately differentiated adenocarcinomas. LN metastases were associated significantly with lymphatic invasion. CONCLUSIONS: These results suggest that early rectal carcinomas should be resected surgically if they 1) show massive submucosal invasion, 2) are classified as moderately differentiated adenocarcinomas, and 3) are larger than 10 mm in diameter. In patients with both scanty submucosal invasion and features of well-differentiated adenocarcinoma or intramucosal carcinoma and if no other risk factors for LN metastasis are present, such as lymphatic invasion by the primary lesion, surveillance may suffice after endoscopic resection.
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References
Usui Y, Kondo K, Satou T, Satou M, Hamada S, Kitamura S. A case of type IIC cancer having submucosal venous invasion without direct submucosal invasion. J Jpn Soc Colo-proctol 1991;44:1089–92.
Shatney CH, Lober PH, Gilbertsen VA, Sosion H. The treatment of pedunculated adenomatous colorectal polyps with focal cancer. Surg Gynecol Obstet 1974;39:845–50.
Shinya H, Cooperman A, Wolff WI. A rationale for the endoscopic management of colonic polyps. Surg Clin North Am 1982;65:861–7.
Christie JP. Polypectomy or colectomy? Management of 106 consecutively encountered colonic polyps. Am Surg 1988;54:93–9.
Langer JC, 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, Macrae FA, Williams CB. Histopathology and prognosis of malignant colorectal polyps treated by endoscopic polypectomy. Gut 1984;25:437–44.
Bartnik W, Butruk E, Orlowska J. A conservative approach to adenomas containing invasive carcinoma removed colonoscopically. Dis Colon Rectum 1985;28:673–5.
Conte CC, Welch JP, Tennant R, Folouhar F, Lundy J, Bloom GP. Management of endoscopically removed malignant colon polyps. J Surg Oncol 1987;36:116–21.
Wolff WI, Shinya H. Definitive treatment of “malignant” polyps of the colon. Ann Surg 1975;182:516–25.
Shlomo K, Louis RB, Philip HG, Benjamin M. The care of patients with colorectal polyps that contain invasive adenocarcinoma. Cancer 1992;70:2044–50.
Minamoto T, Mai M, Ogino T,et al. Early invasive colorectal carcinomas metastatic to the lymph node with attention to their nonpolypoid development. Am J Gastroenterol 1993;88:1035–9.
Jass JR, Sobin LH. International histological classification of tumours. 2nd ed. Berlin: Springer-Verlag, 1989.
Kudo S. Endoscopic mucosal resection of flat and depressed types of early colorectal cancer. Endoscopy 1993;25:455–61.
Karita M, Tada M, Okita M, Kodama M. Endoscopic therapy for early colon cancer: the “strip biopsy” resection technique. Gastrointest Endosc 1991;37:128–32.
Haruma K, Sumii K, Inoue K, Teshima H, Kajiyama G. Endoscopic therapy in patients with inoperable early gastric cancer. Am J Gastroenterol 1990;85:522–6.
Ishi H, Tatsuta M, Tsutsui S,et al. Early depressed adenocarcinomas of the large intestine. Cancer 1992;69:2406–10.
Abulkalam MS, Kato Y, Kunishima N, Sugano H, Benjamin FT. Carcinoma in nonpolypoid mucosa of the large intestine: report of a case with significance in strategies for early detection. Cancer 1985;56:2849–54.
Kuramoto S, Oohara T. Flat early cancers of the large intestine. Cancer 64;1989:950–6.
Adachi M, Muto T, Morioka Y, Ikenaga T, Hara M. Flat adenoma and flat mucosal carcinoma (IIb type)—a new precursor of colorectal carcinoma? Report of two cases. Dis Colon Rectum 1988;31:236–43.
Francoise M, Francois D, Bertrand N, Francois B, Rene L. Failure of endoscopic detection of ade novo carcinoma of the colon in a patient with adenomatous polyps. Gastrointest Endosc 1992;32:703–6.
Oseki Y, Saiga T, Matsubara N, Koyama A, Honma M, Koyama N. Depressed type mucosal cancer of large intestine with converging mucosal folds: report of a case. Dig Endosc 1992;4:153–8.
Byron EC, Wayne FS. Small nonpolypoid carcinomas of the large intestine. Cancer 1983;51:1760–3.
Santhat N, Arun R, Herbert MR,et al. The risk of lymph node metastasis in colorectal polyps with invasive adenocarcinoma. Dis Colon Rectum 1991;34:323–8.
William OR, William AW, Steven JM,et al. Patient management after endoscopic removal of the cancerous colon adenoma. Ann Surg 1987;205:665–72.
Coverlizza S, Risio M, Ferrari A, Preiser MF, Rossini FP. Colorectal adenomas containing invasive carcinoma: pathologic assessment of lymph node metastatic potential. Cancer 1989;64:1937–47.
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Tanaka, S., Yokota, T., Saito, D. et al. Clinicopathologic features of early rectal carcinoma and indications for endoscopic treatment. Dis Colon Rectum 38, 959–963 (1995). https://doi.org/10.1007/BF02049732
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DOI: https://doi.org/10.1007/BF02049732