Okabe S, Arai T, Maruyama S, Murase N, Tsubaki M, Endo M
First Department of Surgery, Tokyo Medical and Dental University, Japan.
Surg Today. 1998;28(7):687-95. doi: 10.1007/BF02484613.
Due to recent advances in endoscopic surgical techniques, it has now become possible to perform endoscopic resection of most early invasive carcinomas of the colon and rectum (EIC) even if the lesions have invaded the submucosa. In the present study, we investigated the microscopic characteristics of superficial EIC compared with protruding-type EIC, focusing particular attention on histological type, the presence or absence of vascular invasion, the extent of submucosal invasion, and other adverse prognostic factors, to establish appropriate treatment strategies. Our findings led us to conclude that: (1) most cases of EIC can be cured by endoscopic resection if their gross aspects are classified as type IIc, superficial depressed, or type IIa, superficial elevated; (2) colorectal resection with lymph node dissection should be performed first for type IIa + IIc EIC because these lesions are apt to be associated with a large number of adverse prognostic factors; (3) subsequent colorectal resection should be performed after initial endoscopic treatment of EIC if there are adverse prognostic indicators of metastasis in the endoscopically resected specimen, such as moderately or poorly differentiated adenocarcinoma, lymphatic invasion, venous invasion, or extensive submucosal invasion.
由于内镜手术技术的最新进展，现在即使病变已侵犯黏膜下层，也能够对大多数早期结肠和直肠癌浸润癌（EIC）进行内镜切除。在本研究中，我们研究了浅表型EIC与隆起型EIC相比的微观特征，特别关注组织学类型、是否存在血管侵犯、黏膜下层侵犯程度以及其他不良预后因素，以制定合适的治疗策略。我们的研究结果使我们得出以下结论：（1）如果EIC的大体形态分类为IIc型（浅表凹陷型）或IIa型（浅表隆起型），大多数病例可通过内镜切除治愈；（2）对于IIa + IIc型EIC，应首先进行结直肠切除并清扫淋巴结，因为这些病变容易伴有大量不良预后因素；（3）如果在内镜切除标本中存在转移的不良预后指标，如中分化或低分化腺癌、淋巴管侵犯、静脉侵犯或广泛的黏膜下层侵犯，则应在对EIC进行初始内镜治疗后进行后续的结直肠切除。
