Treatment of Is (Sessile) Type Colorectal Submucosal Carcinomas (from the Standpoint of Physician): Special Reference to Indication for Endoscopic Therapy Yusuke Saitoh 1 , Jiro Watari 1 , Takanori Fujiki 1 1The Third Department of Internal Medicine, Asahikawa Medical College Keyword: Is型早期大腸癌 , sm深部浸潤 , 内視鏡治療 pp.1489-1501
Published Date 1997/10/25
DOI https://doi.org/10.11477/mf.1403105226
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 During the period between January 1990 and December 1996, there were 135 Is type lesions out of 695 lesions of early colorectal carcinoma. Those Is type early colorectal carcinomas were studied to clarify the indication for endoscopic treatment. Submucosal invasion rate of Is type early cancer was 42.2%, which was significantly higher than those of other protruding types of early cancer 〔Ip (pedunculated) and Isp (subpedunculated) types〕 and was the same as that of Ⅱa (flat elevated) type cancer. There were 19 lesions of moderately and massively extended Submucosal cancers that were initially treated by the endoscopic resection then followed by surgical operation, because there found carcinomatous invasion at the resected margin or lymphatic invasion in the specimens removed by the EMR or endoscopic polypectomy. Almost half of them (nine cases) were Is type by the macroscopic classificasion and their average size was 12.4 mm in diameter. This average size of these nine lesions that were initially treated endoscopically was significantly smaller than that of the Is type early colorectal cancers with sm2~sm3 invasion which were initially treated surgically. Useful colonoscopic findings indicating sm2~sm3 invasion of Is type cancer were as follows; i) smooth with nodular surface, ii) depression on the surface, iii) expansive appearance, iv) normal mucosa at the border of the tumor. In conclusion, we should be careful to diagnose the depth of invasion of Is type early carcinoma especially around 10 mm in size before endoscopic treatment, because it was generally thought to be less aggressive than the Ip and Isp type early colorectal carcinomas.

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