Indications and Limits of Endoscopic Surgery for Colorectal Diseases

Mahito Imajo, Takeo Iwama, Yasushi Ookubo, Kunio Tsukada, Ikuo Hojo, Yasuyuki Kawachi, Hideyuki Ishida, Yoshikimi Nishioka, Takuzou Yamazaki, Hiroyuki Fukunari, Yoshiki Toyama, Yoshio Mishima

Second Department of Surgery, Tokyo Medical and Dental University

To determine the indications for and limitations of endoscopic surgery for colorectal diseases, our experience with 1927 polyps treated by endoscopic surgery and 259 early colorectal carcinomas is reviewed. Of these polyps, 67% were adenomas, 5% were mucosal carcinomas, 3% were Peutz-Jeghers polyps, 1% were juvenile polyps and 0.4% were benign submucosal tumors. Endoscopic surgery is recommended as adequate therapy for these colorectal diseases. The size limit for polyps treated by colonoscopic polypectomy was 45 mm in diameter. The complication rate after endoscopic surgery was 0.7%. There were no deaths in this series and endoscopic surgery was a safe procedure. The histopathological features of early colorectal carcinomas were analyzed. The results of this study indicate that endoscopic surgery for mucosal carcinomas could be acceptable as proper treatment, because preoperative estimation of lymph node metastasis of submucosal carcinomas could not be found. The patients with early carcinomas that are pedunculated (type Ip) regardless of size, sessile protruded (type Is) smaller than 20 mm and flat elevated (type IIa) smaller than 15 mm should undergo endoscopic surgery. The depressed type (IIa + IIc) of early colorectal carcinomas should be treated by surgery because of increased risk of submucosal invasion and lymphatic or venous invasion.

Key words
endoscopic surgery, colonoscopic polypectomy, early carcinoma of the large bowel

Reprint requests
Mahito Imajo Second Department of Surgery, Tokyo Medical and Dental University
1-5-45 Yushima, Bunkyo-ku, Tokyo, 113 JAPAN

Accepted
July 3, 1991

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