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Updated: Jun 12, 2026
08:26
Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction
Published on: March 24, 2023
Our perspective on endoscopic resection for colorectal neoplasms
1Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan. tamatsud@ncc.go.jp
Gastroenterologie Clinique Et Biologique
|June 26, 2010
Summary
Endoscopic submucosal dissection (ESD) offers en-bloc resection for large colorectal lesions, unlike piecemeal endoscopic mucosal resection (EMR). However, ESD is not yet standard, and mastering EMR and surveillance is crucial.
Area of Science:
- Gastroenterology
- Endoscopic Surgery
- Colorectal Oncology
Background:
- Endoscopic mucosal resection (EMR) is effective for early colorectal lesions but has high recurrence rates for large lesions treated piecemeal.
- Endoscopic submucosal dissection (ESD) enables en-bloc resection regardless of lesion size, a standard in upper GI tract early cancers.
- ESD for colorectal lesions is under investigation but not yet a standard therapeutic method.
Purpose of the Study:
- To define indications for en-bloc resection of specific colorectal lesions based on clinicopathological analysis.
- To highlight the challenges and limitations of current endoscopic resection techniques for large colorectal neoplasms.
- To emphasize the importance of fundamental endoscopic techniques and post-treatment surveillance strategies.
Main Methods:
- Clinicopathological analysis to determine criteria for en-bloc resection.
- Review of clinical studies on endoscopic submucosal dissection (ESD) for colorectal lesions.
- Evaluation of the prevalence of lesions suitable for ESD in the context of all neoplastic lesions and early cancers.
Main Results:
- Indications for en-bloc resection include laterally spreading tumor non-granular (LST-NG) type >20 mm and LST granular (LST-G) type >40 mm, both having high submucosal invasion rates.
- LST-NG lesions >20 mm are difficult to resect completely with piecemeal EMR, indicating a strong need for en-bloc resection.
- Lesions suitable for ESD represent a small proportion (1.0% of neoplastic lesions, 5.0% of early cancers).
Conclusions:
- ESD is ideal for en-bloc resection of specific large colorectal lesions, but its limited prevalence necessitates proficiency in other techniques.
- Mastering fundamental endoscopic resection methods and understanding surveillance strategies are critical for managing early colorectal cancers.
- Further research and standardization are needed for widespread adoption of ESD in colorectal practice.
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