| Theme |
What endoscopists should know about laparoscopy-assisted colectomy |
| Title |
Ideal endoscopic treatment of colorectal cancer from a viewpoint of laparoscopic surgery |
| Author |
Junji Okuda |
Department of General and Gastroenterological Surgery, Osaka Medical College |
| Author |
Masao Toyoda |
Department of General and Gastroenterological Surgery, Osaka Medical College |
| Author |
Nobuhiko Tanigawa |
Department of General and Gastroenterological Surgery, Osaka Medical College |
| [ Summary ] |
Endoscopic mucosal resection (EMR) is definitely the least invasive treatment of mucosal colorectal cancer, including adenoma. Indications for EMR have been extended to larger mucosal tumors with improvement in techniques, such as piece meal resection (EPMR). It is also useful for some submucosal cancers, based on the analysis of clinicopathological findings of resected specimens. Recently, laparoscopic surgery has been applied to treatment of early colorectal cancer and selected advanced cancers as a less invasive procedure compared to conventional open surgery. We describe the current indications, effective tumor identification, methodology and future strategies for laparoscopic surgery for treatment of colorectal cancer. Although EMR appears to be the optimal modality for laterally spreading tumors over 3cm, in cases where the tumor could not be resected completely, even with EPMR, laparoscopic resection might be feasible not only for its curative intent but also to produce a better quality of life. EMR for submucosal cancer with extended indications should be performed by skilled endoscopists under informed consent, followed by meticulous pathological examination. In cases where the residual cancer might be suspected at the vertical resection line, laparoscopic surgery should be recommended as a less invasive and better therapy instead of follow-up. Intensive collaboration between endoscopists and surgerons is mandatory to develop the best therapy for each patient with colorectal cancer. |