INDICATIONS OF ENDOSCOPIC RESECTION FOR MINIMALLY SUBMUCOSA-INVASIVE COLORECTAL CARCINOMA : ANALYSIS OF 330 EARLY COLORECTAL CARCINOMA LESIONS

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Background and aim : Intramucosal and minimally submucosa-invasive colorectal carcinoma can be treated with endoscopic resection. This study was undertaken to develop the criteria which can be used to distinguish between these carcinoma and massively submucosa-invasive one as an aid in the development of a treatment plan. Patients and methods : The sizes, shapes, histologic types, levels of invasion, and endoscopic findings of 330 early colorectal carcinoma resected endoscopically or by laparotomy were analyzed using a logistic regression analysis. Correlations between the histologic types, macroscopic findings (size and shape) or endoscopic findings, and the invasion levels of these lesions were investigated. Results : Few (4%, 12/305) of the well-differentiated, but not other histologic type lesions contained massively submucosa-invasive carcinoma. Further, no superficially elevated, 4.3% (1/23) of the creeping (120 mm in size), and 2.2% (2/93) of the pedunculated tumors (8 and 30 mm in size) were also massively submucosa-invasive. Interestingly, a logistic regression analysis revealed that only the endoscopic finding, impression of tenseness, suggests massive invasion to the submucosa layer. The same analysis technique also indicated that all depressed and semipedunculated/sessile tumors over 20 mm in size could be massively submucosa-invasive. Conclusions : Our data suggest that the early colorectal well-differentiated carcinoma which belongs to the superficially elevated type in any size, and the creeping or pedunculated type less than 20 mm in size can be treated with endoscopic resection. However, other histologic type and the depressed lesions as well as the semipedunculated/sessile ones over 20 mm in size should be resected by laparotomy. The lesions endoscopically presenting impression of tenseness should be also treated with laparotomy.
名古屋市立大学の論文
2002-04-30

INDICATIONS OF ENDOSCOPIC RESECTION FOR MINIMALLY SUBMUCOSA-INVASIVE COLORECTAL CARCINOMA : ANALYSIS OF 330 EARLY COLORECTAL CARCINOMA LESIONS

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