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Treatment Strategy After Endoscopic Resection for Colorectal T1(SM) Cancer: Present Status and Future Perspective

  • Shinji TanakaEmail author
  • Shiro Oka
  • Kazuaki Chayama
Chapter

Abstract

Recent progress of endoscopy such as endoscopic submucosal dissection (ESD) enabled to resect Tis/T1 colorectal cancer endoscopically en bloc regardless of its size. In this chapter, we assessed the present status and future perspective of management for Tis/T1 colorectal cancer. Recently, according to the accumulation of many cases and detailed evaluation, after complete endoscopic en bloc resection for T1 colorectal cancer, if below all conditions are satisfied in histological examination, it can be considered curative resection: (1) submucosal invasion depth less than 1000 μm, (2) favorable histologic grade, (3) no vessel involvement, and (4) low budding grade. On the other hand, recent studies revealed that even for T1b cancer, if there are no other metastatic risk factors, estimated lymph node metastatic risk is 1.2–0.4%. On the basis of this evidence, endoscopic treatment is gradually becoming more commonly used to achieve total excisional biopsy even for cT1b colorectal carcinoma. At present, there has been evaluated as clinical research regarding the feasibility of endoscopic resection as total excisional biopsy for T1 cancer that have previously been indicated for surgery. In the future, it is expected to be able to apply molecular markers for judgment for curability after endoscopic resection.

Keywords

T1 colorectal cancer Colorectal SM cancer Lymph node metastasis Endoscopic resection Additional surgery 

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Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  1. 1.Department of EndoscopyHiroshima University HospitalHiroshimaJapan
  2. 2.Department of Gastroenterology and MetabolismHiroshima University HospitalHiroshimaJapan

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