The indication of endoscopic treatment for early colorectal cancer

Aims This study was performed retrospectively to investigate the indication of the endoscopic treatment for early colorectal cancer(ECC). Methods Clinical and pathological features of 91 lesions in 84 patients with ECC were examined. All lesions had been resected endoscopically or surgically at Asan Medical Center between June 1989 and August 1996. Results Macroscopically, 49 (67%) out of 73 protruded types were confined to the mucosa, while 10 (71%) out of 14 flat or dpressed types had submucosal lesion. The remaining 4 lesions were laterally spreading tumors including 3 mucosal and 1 submucosal lesions. Forty seven (79.7%) out of 59 well differentiated aderiocarcinomas were limited to mucosal layer, and 22 (68.8%) dut of 32 moderately or poorly differentiated adenocarcinomas were submucosal lesions. There was no significant correlation between the size of the lesion and the depth of invasion. Of the 64 specimens resected surgically, 33 were mucosal lesions and 31 were submucosal lesions. None of mucosal lesions showed metastasis to regional lymph nodes, while 4 out of 3: submucosal lesions (12.9%) revealed lymph node metastasis. Among 4 carcinomas with metastasis, 3 lesions invaded deep submucosal layer, and one lesion was superficial submucosal cancer. Venous invasion was noted in one case which had submucosal lesion. Of the 27 lesions resected endoscopically, submucosal lesion was found in 18.5% (n=5) ; all submucosal lesions were limited to superficial submucosal layer. Of the 5 patients, four patients are alive and well without evidence of local recurrence with a follow-up period ranging from 4 to 43 months (median, 22 months) except for one patient who died of unrelated illness 13 months later. Conclusions These results suggest that endoscopic treatment might be sufficient in ECC with 1) mucosal and superficial submucosal lesion, 2) well differentiated type of adenocarcinoma, and 3) no evidence of lymphatic or venous invasion.