The Choice of an Endoscopic Resection or a Surgical Resection Based on the Surgical Cases of Early Rectal Cancer

Toshihito Sawada, Takeshi Hayakawa, Takehiko Dohi, Masaki Ueno, Yoshihiro Kinoshita, Kenji Tsutsumi, Masamichi Matsuda, Yoshiaki Kajiyama, Masashi Hashimoto, Harusi Udagawa, Goro Watanabe, Masahiko Tsurumaru

Department of Gastrointestinal Surgery, Toranomon Hospital

Preserving defection, urination and sexual functions while maintaining radicality is a point which must be considered in choosing endoscopic versus surgical resection in early rectal cancer. The exact diagnosis of the depth of invasion is the msot important point in selecting the appropriate treatment. Detecting vascular invasion is essential determining whether minimally invasive, reduction surgery is feasible. The ratio of lymph node metastasis in early rectal cancer was 4.8% in sml cases and 19.3% in sm2,3 cases. When we divided the cases into vascular invasion (-) and vascular invasion (+) groups, there was a significant difference between the ratios of lymph node metastasis (the former-0.0% and the later-2.6%). In order to avoid rectal amputation for lesions of the lower part of the rectum (P and Rb near by P), treatment selection should be based strictly and precisely on determination of the depth of invasion and the existence of vascular invasion as revealed in samples obtained by endoscopic or local resection. The ratio of lymph node metastasis was extremely low in sm2,3 cases without vascular invasion, and in sml cases. Therefore, endoscopic or local resection is feasible in most of these cases, such that rectal amputation can be avoided. In cases requiring extensive and lymph node dissection, D₁ lymph node dissection (upper side D₂ and lateral side D₁) is preferred over D₂ or D₃ dissection, because all cases with lymph node metastasis were n1 (+). We consider this to be the only treatment which guarantees full preservation of autonomic function.

Key words
submucosal invasive cancer, treatment for early rectal cancer, endoscopic mucosal resection

Reprint requests
Toshihito Sawada Department of Gastrointestinal Surgery, Toranomon Hospital
2-2-2 Toranomon, Minato-ku, Tokyo, 105 JAPAN

Accepted
December 11, 1996

To read the PDF file you will need Abobe Reader installed on your computer.