Mid-Term Prognosis After Endoscopic Resection for Submucosal Colorectal Carcinoma: Summary of a Multicenter Questionnaire Survey Conducted by the Colorectal Endoscopic Resection Standardization Implementation Working Group in Japanese Society for Cancer O

Abstract

We carried out a retrospective questionnaire survey of 792 submucosal colorectal carcinoma (CRC) cases from 15 institutions affiliated with the Colorectal Endoscopic Resection Standardization Implementation Working Group in Japanese Society for Cancer of the Colon and Rectum. In these cases, endoscopic resection (ER) and surveillance was carried out without additional surgical resection. Local recurrence or metastasis was observed in 18 cases. Local submucosal recurrence was observed in 11 cases, and metastatic recurrence was observed in 13 cases. Among the 15 cases in which the depth of submucosal invasion was measured, two cases showed depth less than 1000 µm, which has other risk factors for metastasis. Metastatic recurrence was observed in the lung, liver, lymph node, bone, adrenal glands, and the brain; in some cases, metastatic recurrence was observed in multiple organs. Death due to primary disease was observed in six cases. The average interval between ER and recurrence was 19.7 ± 9.2 months. In 16 cases, recurrence was observed within 3 years after ER. Thus, validity of ER without additional surgical resection for cases with the conditions that the depth of submucosal invasion is less than 1000 µm and the histological grade is well or moderately differentiated adenocarcinoma with no lymphatic and venous involvement was proven.

Management of T1 colorectal carcinoma with special reference to criteria for curative endoscopic resection

“…In a previous JSCCR research project, we reported mid‐term outcomes of endoscopically treated submucosal invasive colorectal carcinomas that were followed up without additional surgery, and the validity of the JSCCR guideline criteria under which endoscopic resection is considered to be curative 24 . The study confirmed that submucosal invasion < 1000 µm, well‐/moderately‐differentiated adenocarcinoma, and absence of vascular invasion are reliable criteria 24 .…”

“…In a previous JSCCR research project, we reported mid‐term outcomes of endoscopically treated submucosal invasive colorectal carcinomas that were followed up without additional surgery, and the validity of the JSCCR guideline criteria under which endoscopic resection is considered to be curative 24 . The study confirmed that submucosal invasion < 1000 µm, well‐/moderately‐differentiated adenocarcinoma, and absence of vascular invasion are reliable criteria 24 . We have also previously reported that if differentiation of the submucosal invasive front is considered, complete cure by endoscopic treatment is possible for colorectal carcinomas invading the submucosa to a depth of 1500 µm but showing no vascular invasion 25–27 .…”

Endoscopic Submucosal Dissection as Total Excisional Biopsy for Clinical T1 Colorectal Carcinoma

“…On the other hand, the local and/or metastatic recurrence rate after endoscopic resection of T1 CRC was reported to be very low (0-2.3%) in the absence of risk factors for LN metastasis other than submucosal invasion depth [16,18,19,27]. Subsequent surgery is therefore not likely to be absolutely essential in all of these T1 CRC patients.…”

Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer

“…Furthermore, project research is currently in progress into other histopathological factors. Multi-center joint research projects have produced reports providing results from consideration of the appropriateness of these criteria [132][133][134]. None of the guidelines in other countries includes depth of invasion or budding as criteria for additional treatment.…”