Clinicopathological Studies and Treatment of 17 Cases of Flat Elevation with Central Depression Type Early Colorectal Cancer

Manabu Fujiyoshi, Masahiro Takano, Tateshi Fujiyoshi, Koichi Takagi, Yoriyuki Tsuji, Akira Hamada, Toshiharu Sasaki

Coloproctology Center, Takano Hospital

The clinicopathological features and treatment of flat elevation with central depression (IIa+IIc) type early colorectal cancer were studied. Three hundred and twenty four cases of early colorectal cancer were experienced in the past 7 years. There were 17 cases of IIa+IIc type early colorectal cancer comprising 5.2% of all early colorectal cancer cases. Seven of the 17 cancers were mucosal and 10 were submucosal. When the 17 cancers were examined macroscopically, they were found to be divided into Ul (+) type which had clear ulceration and Ul (-) type without it. Eight of the 17 cases were of the Ul (+) type. They were all submucosal cancer and the incidence of vessel invasion, lymphnode metastasis and liver metastasis was high. There were 9 cases of the Ul (-) type of which 7 were mucosal cancer and 2 submucosal cancer. One of the 17 patients underwent endoscopic polypectomy alone and 2 underwent curative trans-anal and trans-sacral resection respectively. This division of IIa+IIc type early colorectal cancer into Ul (+) and Ul (-) is clinically useful and for Ul (-) type at the lower rectum, local excision could be done at the first trial and the need for radical resection should be decided on the basis of the pathological findings.

Key words
early colorectal cancer, flat elevation with central depression type (IIa+IIc type)

Reprint requests
Manabu Fujiyoshi Coloproctology Center, Takano Hospital
4-2-88 Obiyama, Kumamoto, 862 JAPAN

Accepted
October 9, 1991

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