The treatment of early colorectal cancer

One hundred and eighty-three patients with early colorectal cancer (mucosal or submucosal carcinoma) were treated endoscopically or surgically from 1962 through 1984 at our hospital. Regional lymph node metastasis was recognized in 6 among 98 submucosal cancers. Lymphatic vessel permeation of cancer cells was also found in 31.8% of submucosal cancers. Local recurrence was observed in 3 patients with submucosal cancer. From our experience, the policy of treatment for early cancer was discussed and proposed. If the growth is pedunculated or small sessile polyp endoscopic polypectomy should be performed and bowel resection must be subsequent when histological examination of resected specimen showed massive cancer invasion to the stalk or submucosal layer. If the growth does not have stalk and is diagnosed early cancer, bowel resection with dissection of surrounding tissues should be recommended for high security, because these growth has more frequently submucosal invasion. For early rectal cancer, transanal or trans-sacral local wedge excision for mucosal or submucosal minute invasion cancer and trans-sacral sleeve resection with dissection of mesorectal tissues for submucosal invasive cancer. When histological examination of resected specimen showed unexpectively more massive invasion near to or into propria muscle layer, more wide bowel resection must be subsequent. If sm massive cancer locates near to anal canal, limited Miles' operation must be also in mind, preserving voiding and sexual functions.