[Controversy between endoscopic and surgical treatment against early gastric and colorectal cancer].

Although endoscopic treatment against the patients with early cancer in gastrointestinal tract is an excellent method especially in high aged or poor risk patients, there still exists controversy about the indication for endoscopic treatment because of deeper invasion of the cancer or lymph node metastases. In order to clarify whether the patient has a possibility of nodal involvement or not, we made the clinicopathological analysis concerning 220 cases with early gastric cancers and 118 cases with colorectal cancers. Our retrospective analysis shows that endoscopic resection can be indicated for small polypoid cancer less than 10 mm in size, excluding IIa + IIc type. As to small depressed type, this procedure should be applied for IIc type which is well differentiated adenocarcinoma without ulcer formation (U1 (-)). Regarding early colorectal cancer there has been many discussion how to treat the patients with sm-cancer. Based on our analysis of 39 cases with sm-cancer, we led to the conclusion that the characteristics of sm-cancer with lymph node metastases are i) massive invasion into submucosal layer, ii) positive lymphatic permeation, or iii) "de novo" cancer. As a result, a decision of further surgery should be made even in small lesions less than 10 mm, taking the fact into consideration of the possibility of nodal involvement of sm-cancer.