Clinical outcomes of submucosal colorectal cancer diagnosed after endoscopic resection: a focus on the need for surgery

Abstract

cancer by routine screening tests and to then treat them to block further development into advanced colorectal cancer. Thus, clinical practice guidelines suggest various screening tests including colonoscopy. 3-5 Colonoscopy is especially useful due to its ability to detect and treat precancerous polyp and early colorectal cancer. 6 Of early colorectal cancers, superficial submucosal colorectal cancer (SSMC) defined by the depth of invasion from muscularis mucosa as less than 1,000 μm, can be completely cured by endoscopic resection if it does not have any adverse pathologic findings including poorly differentiated adenocar

Deep Submucosal Invasion Is Not an Independent Risk Factor for Lymph Node Metastasis in T1 Colorectal Cancer: A Meta-Analysis

“…[7][8][9] Although 70%-80% of patients are classified as high risk using these criteria, the vast majority (>90%) will end up lymph node-negative on histologic evaluation of the surgical specimen. 10 Surgical overtreatment remains a major issue in T1 CRC and optimal management must strike the right balance between oncologic safety and minimizing treatment-associated morbidity and mortality. 11,12 Guidelines consider DSI a high-risk factor for LNM and strong indicator for radical surgery.…”

Comment on " Positive fecal immunochemical test results are associated with non-colorectal cancer mortality"

“…Colonoscopy is gaining popularity as a population-based CRC screening tool because it allows the evaluation of the entire intestine at once, can remove precancerous or early CRC lesions, and has a longer examination interval than other CRC screening tests [6,7]. However, information on the appropriate timing and linkage to colonoscopy after a positive FOBT remains insufficient.…”

Endoscopic diagnosis and treatment of early colorectal cancer

“…20,61 In other words, a substantial number of patients undergo unnecessary surgery. 23,57,59,62 Various attempts are being made to overcome the shortcomings of the current guidelines and to increase the accuracy of the prediction of LN metastasis in ECC.…”

“…However, the rate of pathologically confirmed LN metastasis after surgical resection was estimated to be approximately 10% in patients whose endoscopic resection specimens showed unfavorable histologic features [ 20 , 61 ]. In other words, a substantial number of patients undergo unnecessary surgery [ 23 , 57 , 59 , 62 ]. Various attempts are being made to overcome the shortcomings of the current guidelines and to increase the accuracy of the prediction of LN metastasis in ECC.…”