title: New indication for endoscopic treatment of colorectal carcinoma with submucosal invasion.
abstract: OBJECTIVE
  Although an increasing number of early colorectal cancers (CRC) have been curatively treated by endoscopy, there have been no definitive criteria to decide the effectiveness of such therapy. We retrospectively analyzed clinicopathological factors to establish criteria for curative endoscopic treatment of early CRC.
  
  
  METHODS
  First, risk factors of lymph node metastasis were analyzed in 171 patients who received surgery with postoperative histology of CRC submucosal invasion. The resultant new criteria were evaluated in another 60 patients who experienced endoscopic resection of CRC and surgery according to the current criteria most often used in Japan.
  
  
  RESULTS
  In the first substudy, lymph node metastasis was present in 18 of 171 patients (10.5%). Lymphatic permeation, sprouting and infiltrative growth of cancer cells were identified as histological factors significantly related to lymph node metastasis, and observed in much higher rates when the depth of submucosal invasion was beyond 1,500 micron. The minimum depth with positive lymph nodes was 1,075 micron. In the second group of 60 patients, lymph node metastasis was recorded in none of nine patients who met our new criteria of complete endoscopic treatment: submucosal invasion below 1,500 micron in depth, and no lymphatic permeation, sprouting or infiltrative growth pattern on tumor histology. Lymph node metastasis was positive in three of the other cases who did not meet our new criteria.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Third Department of Internal Medicine, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kyoto, Japan. simomura@sun.kpu-m.ac.jp
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Shimomura
authors.forename: Shingo
authors.initials: S
authors.lastname: Ishiguro
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Konishi
authors.forename: Naoki
authors.initials: N
authors.lastname: Wakabayashi
authors.forename: Shoji
authors.initials: S
authors.lastname: Mitsufuji
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Kasugai
authors.forename: Masayuki
authors.initials: M
authors.lastname: Manou
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kodama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D016015:Logistic Models; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology*; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome