| Theme | The point of treatment between endoscopic resection and laparoscopic surgery in colorectal tumor | |
|---|---|---|
| Title | The management of treatment for early colorectal cancer -- what are the appropriate times to use laparoscopy or endoscopy? | |
| Publish Date | 1999/09 | |
| Author | Hirotoshi Hasegawa | Department of Surgery, Keio University School of Medicine |
| [ Summary ] | The least invasive modality for treatment of early colorectal cancer is endoscopic resection. It is important that treatment be both less invasive and curative. Laparoscopic surgery provides en bloc resection of tumours, with enough margin for accurate histopathological examinations, but requires hospital admission, general anaesthesia and a skin incision. The crossover point from the use of endoscopic treatment to laparoscopic surgery is reached when the tumour can not be removed endoscopically. The criteria for borderline case is ; tumours which are invading into mucosa or submucosa (sm1), 3cm in diameter for Is, Isp and granular type of lateral spreading tumour for en bloc resection. There is no limit to the treatable size of pedunculated polyps, if they can be snared. In case of piecemeal polypectomy, 4 cm in diameter is thought to be the maximum treatable size. However, endoscopic resection should be avoided if the non-granular type of a lateral spreading tumour exceeds 2 cm, or a depressed-typed tumour (IIa or IIa+IIc) over 1cm, because they are likely to massively invade into submucosa. Another indication for laparoscopic resection is when a tumour is overriding a fold of the colon, or near the flexure, where it is difficult to control the endoscope and the snare. |
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