| Theme | Update on laterally spreading tumor (LST) | |
|---|---|---|
| Title | Treatment strategy for laterally spreading tumors (LST) based on clinicopathological features and results of endoscopic mucosal resection (EMR) | |
| Publish Date | 2006/09 | |
| Author | Shiro Oka | Department of Endoscopy, Hiroshima University Hospital |
| Author | Shinji Tanaka | Department of Endoscopy, Hiroshima University Hospital |
| Author | Toru Kawamura | Department of Endoscopy, Hiroshima University Hospital |
| Author | Iwao Kaneko | Department of Medicine and Molecular Science, Hiroshima University |
| Author | Hiroyuki Kanao | Department of Medicine and Molecular Science, Hiroshima University |
| Author | Mayuko Hirata | Department of Medicine and Molecular Science, Hiroshima University |
| Author | Ritsuo Mouri | Department of Medicine and Molecular Science, Hiroshima University |
| Author | Shigeto Yoshida | Department of Endoscopy, Hiroshima University Hospital |
| Author | Masaharu Yoshihara | Health Service Center, Hiroshima University |
| Author | Kazuaki Chayama | Department of Medicine and Molecular Science, Hiroshima University |
| [ Summary ] | Based on histologic examination, LST-Gs showed tubular / tubulovillous components in all cases, regardless of size. Type V pit patterns, seen with magnification, enable us to easily recognize the cancerous area in LST-G. Our data showed that large adenomatous LST-Gs can be cured by piecemeal EMR. To reduce residual tumors and local recurrence after EMR, it is important to observe the ulcerated margin by using magnifying endoscopy and to perform appropriate trimming. On the other hand, LST-NGs, especially of the pseudo-depressed type (PD), have a relatively high risk of submucosal invasion. In addition, prior to endoscopic treatment, we cannot correctly recognize the submucosal invasive area in LST-NG-PD with magnifying observation. Therefore, en block resection is necessary in cases of LST-NG-PD, and ESD should be used for large LST-NGs. However, the safety and standardization of colorectal ESD have not been yet established. Treatment strategies for choosing EMR or ESD should be discussed based on the clinicopathological characteristics of the LST subtype, the endoscopists' skill level and the patients' condition. |
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