New indication for endoscopic treatment of colorectal carcinoma with submucosal invasion

Abstract

The present study showed that endoscopic treatment of early CRC may be considered complete when submucosal invasion beyond 1,500 micron, lymphatic permeation, sprouting, and infiltrating growth are all denied.

A three-tier classification system based on the depth of submucosal invasion and budding/sprouting can improve the treatment strategy for T1 colorectal cancer: a retrospective multicenter study

“…Although the implication of budding/sprouting in deeply invasive colorectal cancer was first reported in 1989, 25 many studies have also focused on budding/sprouting as a risk factor of lymph node metastasis in T1 colorectal cancer. [12][13][14][15][26][27][28][29][30][31][32] Some investigators refer to findings similar to budding/sprouting as 'unfavorable histology at the invasive front,' 33 'focal dedifferentiation,' 34 or 'tumor cell dissociation,' 35 although the definition is not always consistent. 13,25,32,36 In the evaluation of budding/sprouting, we adopted the definition of Ueno et al 13 because it is widely used and has good reproducibility.…”

Pathological predictors for lymph node metastasis in T1 colorectal cancer

“…This suggests that differentiation is a predictive factor independent of TB. Previous studies [1][2][3][4][5][6] have shown that the depth of submucosal invasion is a risk factor which can be used for predicting LN metastasis in CRC. A Japanese collaborative study 6 on 865 submucosal invasive CRC cases showed that the rate of LN metastasis is 0% in nonpedunculated T1 CRC if the submucosal invasion depth is less than 1 000 μm.…”

“…[1][2][3][4][5][6][7] Previous studies have demonstrated that several pathological factors, such as histological grade, [7][8][9][10][11][12][13] deep invasion into the submucosal layer, [1][2][3][4][5][6] and lymphatic channel involvement [3][4][5]7,8,[10][11][12][13] are pathological predictors for lymph node (LN) metastasis in T1 CRC. However, it is also known that the pathological evaluation has interobserver variability, which cannot be neglected.…”

“…To date, it has been reported that tumor budding (TB) is a useful marker for the prediction of patient outcome 5,7,[15][16][17] and LN metastasis 5,7,[18][19][20] in CRC. However, TB had not been widely accepted because of the ambiguous defi nition of TB.…”

Colonoscopic Stigmata of 1 mm or Deeper Submucosal Invasion in Colorectal Cancer

“…[1][2][3][4] Recent Japanese studies have demonstrated that stage T1 CRC with a submucosal invasion depth of <1 mm has no possibility of lymph node involvement, provided that other risk factors, e.g., lymphatic channel involvement, venous involvement, and poorly differentiated tumors are absent. [5][6][7][8] Evaluation of the depth of tumor invasion is thus essential when one is deciding the initial treatment for early-stage CRC.…”