RSS-Feed abonnieren
DOI: 10.1055/s-2001-16213
© Georg Thieme Verlag Stuttgart · New York
Endoscopic Treatment for Laterally Spreading Tumors in the Colon
Publikationsverlauf
Publikationsdatum:
31. Dezember 2001 (online)
![](https://www.thieme-connect.de/media/endoscopy/200108/lookinside/thumbnails/10.1055-s-2001-16213-1.jpg)
Background and Study Aims: Laterally spreading tumors (LST) of the colon are best removed by endoscopic mucosal resection (EMR) as they extend laterally rather than vertically. Since they sometimes invade deeply into the submucosal layer, it is important to assess the depth of invasion endoscopically before treatment. In the present study, we examined the endoscopic features of a large number of LSTs in order to assess which features correlated with depth of invasion.
Materials and Methods: 257 LSTs removed at the National Cancer Center Hospital, Tokyo, between January 1988 and September 1998 were retrospectively analyzed.
Results: With univariate analysis, unevenness of nodules, presence of large nodules, size, histological type, and presence of depression in the tumor were significantly associated with depth of invasion. Multivariate analysis revealed that histological type and depression in the tumor were independent factors predicting massive submucosal invasion. When an LST showed: 1) even nodules without depression, or 2) uneven nodules without depression and less than 3 mm in diameter, the risk of massive submucosal invasion was 0 % (0/121) and 3.7 % (3/82), respectively.
Conclusion: When LSTs meet the above endoscopic criteria, EMR should be the first-line treatment because of the low risk of massive submucosal invasion.
References
- 1 Rubesin S E, Saul S H, Laufer I, et al. Carpet lesions of the colon. Radiography. 1985; 5 537-552
- 2 Strekalovsky V P, Odaryuk T S, Veselov V V. Endoscopic surgery for creeping villous tumors of the colon. Gastroenterol Endosc. 1986; 28 1224-1231
- 3 Ishikawa T, Ushio K, Miyagawa K, et al. Nodule-aggregating lesions of the colon: radiologic and endoscopic diagnosis and their clinical courses (in Japanese with English abstract). I to Cho (Stomach and Intestine). 1992; 27 (4) 389-398
- 4 Kudo S. Endoscopic mucosal resection of flat and depressed types of early colorectal cancer. Endoscopy. 1993; 25 455-461
- 5 Kudo S, Kashida H, Nakajima T, et al. Endoscopic diagnosis and treatment of early colorectal cancer. World J Surg. 1997; 21 694-701
- 6 Takahiro F, Oda K, Yoshida S, et al. The features of clinicopathological and genetic background in lateral spreading colorectal tumor: endoscopic diagnosis of the depth of invasion (in Japanese with English abstract). Shoukaki Naishikyo (Digestiva Endoscopia). 1997; 9 (2) 181-191
- 7 Jass J R, Sobin L H. International classification of tumors: histological typing of intestinal tumors. Geneva; World Health Organization, 1991
- 8 Yokota T, Sugihara K, Yoshida S. Endoscopic mucosal resection for colorectal neoplastic lesions. Dis Colon Rectum. 1994; 37 1108-1111
- 9 Usui Y, Kudo K, Satou T, et al. A case of type IIc cancer having submucosal venous invasion without direct submucosal invasion [in Japanese]. J Jpn Soc Coloproctol. 1991; 44 1089-1092
- 10 Shatney C H, Lober P H, Gilbertsen V A, et al. The treatment of pedunculated adenomatous colorectal polyps with focal cancer. Surg Gynecol Obstet. 1974; 39 845-850
- 11 Shinya H, Cooperman A, Wolff W I. A rationale for the endoscopic management of colonic polyps. Surg Clin North Am. 1982; 65 861-867
- 12 Christie J P. Polypectomy or colectomy? Management of 106 consecutively encountered colonic polyps. Am Surg. 1988; 54 93-99
- 13 Langer J C, Cohen Z, Taylor B R, et al. Management of patients with polyps containing malignancy removed by colonoscopic polypectomy. Dis Colon Rectum. 1984; 27 6-9
- 14 Morson B G, Whiteway J E, Jones E A, et al. Histopathology and prognosis of malignant colorectal polyps treated by endoscopic polypectomy. Gut. 1984; 25 437-444
- 15 Bartnik W, Butruk E, Orlowska J. A conservative approach to adenomas containing invasive carcinoma removed colonoscopically. Dis Colon Rectum. 1985; 28 673-675
- 16 Conte C G, Welch J P, Tennant R, et al. Management of endoscopically removed malignant colon polyps. J Surg Oncol. 1987; 36 116-121
- 17 Wolff W I, Shinya H. Definitive treatment of malignant polyps of the colon. Ann Surg. 1975; 182 516-525
- 18 Karita M, Tada M, Okita K, et al. Endoscopic therapy for early colon cancer: the strip biopsy resection technique. Gastrointest Endosc. 1991; 37 128-132
- 19 Tanaka S, Yokota T, Saito D, et al. Clinicopathological features of early rectal carcinoma and indications for endoscopic treatment. Dis Colon Rectum. 1995; 38 959-963
- 20 Tanaka S, Haruma K, Teixeira C R, et al. Endoscopic treatment of submucosal invasive colorectal carcinoma with special reference to risk factors for lymph node metastasis. J Gastroenterol. 1995; 30 710-717
- 21 Tanaka S, Haruma K, Tanimoto T, et al. Ki-67 and transforming growth factor alpha (TGF-α) expression in colorectal recurrent tumors after endoscopic resection. Rec Adv Gastroenterol Carcinogenesis. 1996; 1 1079-1083
- 22 Seike K, Saito N, Koda K, et al. Clinicopathological study on local recurrence of rectal submucosal cancers (in Japanese with English abstract). J Jpn Soc Coloproctol. 1998; 51 284-294
Y. Saito,M.D.
Department of Gastrointestinal Oncology
National Cancer Center Hospital
5-1-1 Tsukiji
Chuo-ku
Tokyo 104
Japan
Fax: + 81-3-35423815
eMail: ytsaito@gan2.ncc.go.jp