Colorectal ESD has gained acceptance as a safe and effective therapeutic option not only in Japan but also in Western countries and is considered as the mainstream treatment for some neoplastic lesions with distinctive features.
ESD for pathological superficial submucosal cancer (pT1a) can be a curative treatment modality by itself if no other risk factors such as lymphovascular invasion, poorly differentiated component, and budding grade 2 or 3 coexist. ESD for pathological deep submucosal cancer (pT1b) might become a potential treatment option in the future; however, surgery is still considered the standard of care to reduce the risk of distant and local recurrences.
The recently developed concept of adjuvant chemoradiotherapy strategy for rectal T1b cancer will start in the near future. If this trial shows successful results, such strategy of CRT after endoscopic R0 resection could become the new standard of care.
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We thank Drs. Hirokazu Taniguchi and Shigeki Sekine for histopathological assessment and Drs. Taku Sakamoto, Masayoshi Yamada, Masau Sekiguchi, Seiichiro Abe, and Takahisa Matsuda for clinical discussions.
Funding: This paper is partially funded by the National Cancer Center Research and Development Fund (25-A-12, 28-K-1 and 29-A-13).
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