演題抄録

臓器別シンポジウム

開催概要
開催回
第55回・2017年・横浜
 

早期大腸癌~診断・治療の現状と将来展望

演題番号 : OSY1-2

[筆頭演者]
田中 信治:1 

1:広島大学・大学院・内視鏡医学

 

Recent development of endoscopy and peripheral equipment such as endoscopic submucosal dissection (ESD) enabled to resect early colorectal carcinoma with en bloc manner regardless of lesion size. The indication of ESD has been clearly described in Japan Gastroenterological Endoscopy Society (JGES) guideline. To determine the indication, pit pattern diagnosis or/and image enhanced endoscopy (IEE) with magnification (Kudo/Tsuruta pit pattern classification, and JNET classification using narrow band imaging) is very useful. This diagnostic technique is helpful in not only invasion depth diagnosis but differentiation between carcinoma and adenoma including focal carcinoma in adenoma. Colorectal ESD has already become feasible in daily practice based on its good outcome.
Regarding T1 carcinoma, as this shows lymph node (LN) metastasis in about 10% of cases, it is necessary to determine the indication for additional surgery with LN dissection after endoscopic resection. Recent accumulation of large number of T1 carcinomas and detailed examination made it possible to do risk stratification of LN metastasis even in deep T1 carcinoma. Concretely, if there are no other risk factors for LN metastasis, risk of LN metastasis of deep T1 carcinoma is only around 1.2%. Based on this fact, possibility of endoscopic resection as a total excisional biopsy for even deep T1 carcinoma became feasible. To conduct this, however, generalization and quality control of diagnostic procedures prior to treatment, skill of endoscopic resection and pathologic diagnosis in nationwide. Also, good biomarker for LN metastasis in addition to pathologic findings is desirable. Further, recently endoscopic full thickness resection is developing and collaboration with endoscopy and surgery such as laparoscopy and endoscopy cooperative surgery (LECS) has been also tried even in colorectal filed.

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