Nivatvongs S
Department of Surgery, Mayo Medical School, Mayo Clinic, Rochester, Minnesota 55905, USA.
World J Surg. 2000 Sep;24(9):1052-5. doi: 10.1007/s002680010148.
An early colorectal carcinoma is TNM stage T1NxMx. Most early carcinomas of the colon and rectum can be treated by adequate local excision, such as colonoscopic polypectomy and per-anal excision. If there are adverse risk factors, especially poorly differentiated carcinoma, lymphovascular invasion, or incomplete excision, a radical resection is indicated if there is no contraindication. In the case of a low rectal carcinoma, adjuvant chemoradiation should be considered. Recently a new classification has been developed: sm1 is invasion to the upper one-third of the submucosa, sm2 is invasion to the middle one-third, and sm3 is invasion to the lower one-third. Lesions of sm1 and sm2 have a low risk of local recurrence and lymph node metastasis; local excision is adequate. The sm3 lesions and sm2 flat and depressed types have a high risk of local recurrence and lymph node metastasis; further treatment is indicated.
早期结直肠癌为TNM分期T1NxMx。大多数早期结肠和直肠癌可通过适当的局部切除进行治疗，如结肠镜息肉切除术和经肛门切除术。如果存在不良风险因素，特别是低分化癌、淋巴管浸润或切除不完全，在无禁忌证的情况下应行根治性切除。对于低位直肠癌，应考虑辅助放化疗。最近制定了一种新的分类：sm1为侵犯黏膜下层上三分之一，sm2为侵犯中三分之一，sm3为侵犯下三分之一。sm1和sm2病变局部复发和淋巴结转移风险低；局部切除即可。sm3病变以及sm2型平坦和凹陷型局部复发和淋巴结转移风险高；需要进一步治疗。
