The decision of the treatment of rectal carcinoma according to the assessment of mural invasion by endoscopic ultrasonography is appropriate.

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• We studied whether the decision of the method of the treatment for rectal carcinoma according to the assessment of mural invasion by endoscopic ultrasonography (EUS) was appropriate. We classified 94 cases of rectal carcinoma into three groups according to the depth of invasion assessed by EUS. In the first group (group-I), the depth of carcinomatous invasion on EUS was the mucosal layer or the superficial submucosal layer. In the second group (group-II), the depth of carcinomatous invasion on EUS was either the deep sub-mucosal layer or the proper muscle layer. In the third group (group-III), the depth of carcinomatous invasion on EUS was beyond the proper muscle layer. Because we have the basic policy of deciding the method of surgery based on the depth of invasion, the endoscopic removal or the local resection is performed in the group-I, the complete autonomic nerve preserving operation (ANPO) is performed in the group-II, the partial ANPO or usual radical operation is performed in the group-III. However, if the endoscopic or local resection is difficult due to the size or the location of the tumor in the group-I, the complete ANPO is performed. The accuracy of EUS was 88.2% in the group-I, 78.6% in the group-II, and 79.6% in the group-III. All of the 6 misjudged cases in the group-II showed the minute extramuscular invasion on histology. Four of the 10 misjudged cases in the group-III showed the inflammatory cell infiltration on histology. We considered that it was impossible to distinguish both the minute extramuscular invasion and the inflammatory cell infiltration from carcinoma tissue by EUS. In the cases in which the judgment by EUS influenced the performed method of surgery, the disease free rate was 93.3% in the group-I, 94.4% in the group-II, 77.5% in the group-III, and only two cases in the group-III showed the local recurrence. We concluded that the decision of the method of the treatment for rectal carcinoma according to the assessment of mural invasion by endoscopic ultrasonography (EUS) was appropriate.

• 社団法人 日本消化器内視鏡学会の論文

社団法人 日本消化器内視鏡学会 | 論文

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