Endoscopic resection as unique treatment for early colorectal cancer.

Colonoscopic screening in developed countries allows detection and resection of a great number of early colorectal cancers. There is a strong controversy to decide when endoscopic treatment is enough or when surgical resection is necessary. To this contributes the diverse names to define the lesions, the wide number of classifications and the different criteria of each author. We perform an extense literature review, aiming to clarify concepts and unify criteria that can be used as a guide for the treatment of early colorectal cancer. We conclude that in early colorectal cancer arising in pedunculated polyps (0-Ip), mucosal endoscopic resection would be indicated as only treatment in Haggitt levels 1, 2 and 3, tumors smaller than 2 cm, well- or moderately differentiated, without vascular or lymphatic affection, with submucosal infiltration lower than 1 microm from the muscularis mucosae and maximal submucosal width lower than 4 microm, and undergoing en bloc resection. In sessile polyps (0-Is) or non-polypoideal elevated (0-IIa) or plain (0-IIb) lesions, recommendations will be similar, without applicability of Haggitt levels.

Resección endoscópica de cáncer colorrectal temprano como único tratamiento / No disponible

El screening mediante colonoscopia que se realiza en paísesoccidentales ha permitido la detección y resección de un númeroelevado de tumores colorrectales en estadio temprano. Existe unagran controversia a la hora de decidir cuándo el tratamiento endoscópicoes suficiente y cuándo debe realizarse la resección quirúrgica.A ello contribuye la gran diversidad en la nomenclaturapara definir estas lesiones, la amplia variedad de clasificaciones delas mismas y los diferentes criterios que tiene cada autor. Medianteuna revisión extensa de la literatura, pretendemos aclarar conceptos,enlazar los datos de las diferentes clasificaciones y unificarunos criterios que sirvan de guía para el tratamiento del cáncercolorrectal temprano. Tras ello, llegamos a la conclusión de queen el cáncer colorrectal temprano que aparece en pólipos pedunculados(0-Ip), estaría indicada la resección endoscópica comoúnico tratamiento en los niveles 1, 2 y 3 de Haggitt, tumores menoresde 2 cm de diámetro, en tumores bien o moderadamentediferenciados, sin afectación vascular ni linfática, con infiltraciónde la submucosa menor de 1 mm desde la muscularis mucosae yanchura máxima en la submucosa menor de 4 mm y resecados enbloque. En las lesiones polipoideas sésiles (0-Is) y no polipoideaselevadas (0-IIa) o planas (0-IIb) las recomendaciones serían las mismasdescritas anteriormente, no siendo aplicables los niveles deHaggitt(AU)

Colonoscopic screening in developed countries allows detectionand resection of a great number of early colorectal cancers.There is a strong controversy to decide when endoscopic treatmentis enough or when surgical resection is necessary. To thiscontributes the diverse names to define the lesions, the wide numberof classifications and the different criteria of each author. Weperform an extense literature review, aiming to clarify conceptsand unify criteria that can be used as a guide for the treatment ofearly colorectal cancer. We conclude that in early colorectal cancerarising in pedunculated polyps (0-Ip), mucosal endoscopic resectionwould be indicated as only treatment in Haggitt levels 1, 2and 3, tumors smaller than 2 cm, well- or moderately differentiated,without vascular or lymphatic affection, with submucosal infiltrationlower than 1 mm from the muscularis mucosae and maximalsubmucosal width lower than 4 mm, and undergoing en blocresection. In sessile polyps (0-Is) or non-polypoideal elevated (0-IIa) or plain (0-IIb) lesions, recommendations will be similar, withoutapplicability of Haggitt levels(AU)