| Theme |
Metastatic recurrence and prognosis after endoscopic treatment for early colorectal carcinoma |
| Title |
Long term outcomes after endoscopic resection and/or surgery in submucosal colorectal cancer |
| Author |
Kensuke Shinmura |
Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East |
| Author |
Yusuke Yoda |
Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East |
| Author |
Hiroaki Ikematsu |
Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East |
| [ Summary ] |
If patients with pT1 colorectal cancer were treated in accordance with Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines, the long-term outcomes are good. Submucosal invasive colorectal cancer with negative vertical margins, well-differentiated or moderately differentiated adenocarcinomas, no evidence of vascular or lymphatic invasions, and invasion depths of less than 1,000µm are classified as being at low risk for lymph node metastasis and local recurrence. Submucosal invasive colorectal cancer lesions that are positive for any of these risk factors are classified as being at high risk for lymph node metastasis. In high risk T1b colorectal cancer, the local recurrence of pT1b rectal cancer without additional surgery was higher than those of pT1b colon cancer. Therefore, the additional surgery for high risk pT1b rectal cancer with local resection should be recommended as the gold standard therapy rather than for colon cancer. However, the rectal surgery, in particular the surgery for lower rectal cancer, is more invasive than the colonic surgery and may affect anal function. That's why some patients tend to reject the rectal surgery. We must consider the new treatment preserving the anal functions for high risk pT1b rectal cancer. |