| Theme |
Invasive colorectal cancer current status and practical issues of depth 1,000μm |
| Title |
Treatment strategies for pSM colorectal cancer after endoscopic resection |
| Author |
Hideki Ueno |
Department of Surgery, National Defense Medical College |
| Author |
Yojiro Hashiguchi |
Department of Surgery, National Defense Medical College |
| Author |
Eiji Shinto |
Department of Surgery, National Defense Medical College |
| Author |
Hideyuki Shimazaki |
Department of Laboratorg, National Defense Medical College |
| Author |
Kazuo Hase |
Department of Surgery, National Defense Medical College |
| [ Summary ] |
For patients with endoscopically resected T1 colorectal cancer (CRC), additional surgical treatment is recommended when the vertical margin is pathologically positive. If any of the following risk factors is observed in the resected specimens, laparotomy should be considered as an additional treatment option; (1) depth of submucosal invasion ≥ 1,000μm, (2) vascular invasion, (3) unfavorable histology (poorly differentiated adenocarcinoma, signet-ring cell carcinoma, mucinous carcinoma), (4) grade 2/3 tumor budding.
We can enumerate three points as the issues to be resolved in this field. First, disagreement on histopathologic assessment of risk parameters; second, problems concerning an excessive number of patients undergoing unnecessary laparotomies with the current surgical indications and third, lack of sufficient data concerning the actual status of extramural recurrence in patients having been treated with conservative approachs for endoscopically resected T1 CRC. These issues must be clarified through well-designed multicenter studies which will offer optimal treatment choices for patients with T1 CRC. |