Progress of Endoscopic Treatment for Early Colorectal Cancers

概要

論文の詳細を見る
The number of patients suffering from colorectal cancers has markedly increased, by 2.5 times in the last 20 years in Japan. Meanwhile, endoscopic diagnosis including magnifying endoscopy and treatment for early colorectal cancers has developed during the same period. The progress of endoscopic resection techniques such as polypectomy, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) has led to changes in therapeutic strategies for early colorectal cancers. ESD is a resection method, which was first developed in Japan as a therapy for early gastric cancers. This endoscopic technique is also a very useful endoscopic procedure, making it possible to perform en bloc resection of colorectal tumors regardless of lesion size. We compared the incidence of perforation and residual/local recurrence associated with colonoscopic treatment. The incidence of perforation was 0.15% with EMR, 0.57% with EPMR, and 0.24% with ESD. This result revealed that ESD has become a very safe procedure similar to the EMR technique. The incidence of residual/local recurrence was 0.6% with EMR, 7.1% with EPMR, and 0% with ESD. Thus, although there is no significant difference in the incidence of perforation between these endoscopic procedures, the rate of residual/local recurrence of EPMR was significantly higher than that of EMR and ESD.<BR>The possibility of completing ESD for colorectal tumor sometimes depends on the existence of fibrosis in the submucosal layer rather than the size and location. ESD was performed for 412 cases of colorectal neoplasm in 401 patients (male:female = 240:161; mean age, 66.9 years). Among these cases, 84 cases were accompanied by SM fibrosis, of which 27 cases were considered related to cancer invasion and 57 cases were unrelated. En bloc resection rate of the tumor without fibrosis was 96.7% (317/328), and the tumor was accompanied with fibrosis in 78.6% (66/84). We experienced only one case of perforation (0.2%), which was accompanied with fibrosis. From the viewpoint of safety and radicality, use of the ESD procedure is thought to be limited for this group at high risk of perforation and recurrence.<BR>For the above reasons, we established a safe resection procedure using laparoscopic and endoscopic cooperative surgery (LECS) in order to perform en bloc resection of tumors for which it is difficult to perform ESD due to fibrosis in the submucosal layer. It is important to establish the limitations of EMR and ESD in the therapeutic strategy for treating early colorectal cancer.

Progress of Endoscopic Treatment for Early Colorectal Cancers

スポンサーリンク

概要

著者

関連論文

スポンサーリンク