J Korean Med Assoc.  2022 Sep;65(9):558-567. 10.5124/jkma.2022.65.9.558.

Multidisciplinary treatment strategy for early colon cancer

• Son GM
• Park SB
• Kim TU
• Park BS
• Lee IY
• Na JY
• Shin DH
• Oh SB
• Cho SH
• Kim HS
• Kim HW

• KMID: 2534373
• DOI: http://doi.org/10.5124/jkma.2022.65.9.558

Abstract

Background
Treatment for early colon cancer has progressed rapidly with endoscopic resection and minimally invasive surgery. Selection of patients without risk of lymph node metastasis is necessary before deciding on endoscopic resection for early colon cancer treatment. We aimed to review the optimal multidisciplinary treatment strategies for early colon cancer, including endoscopy and surgery.
Current Concepts
Pathological risk factors include histologic grade of cancer cell differentiation, lymphovascular invasion, perineural invasion, tumor budding, and deep submucosal invasion. These risk factors for predicting lymph node metastasis are crucial for determining the treatment strategy of endoscopic excision and radical resection for early colon cancer. Prediction of the depth of invasion in early colon cancer using endoscopic optical assessments is vital to determine the appropriate treatment method for endoscopic or surgical resection. Furthermore, optical assessment of pit and vascular patterns is useful for estimating the depth of submucosal invasion using magnifying chromoendoscopy and narrow-band imaging endoscopy. Performing an endoscopic and pathologic evaluation of the risk factors for lymph node metastasis is imperative when selecting endoscopic or surgical resection. Endoscopic treatments include cold snare polypectomy, endoscopic mucosal resection, and endoscopic submucosal dissection. In addition, appropriate surgical treatment should be recommended for patients with early colon cancer with a high risk of lymph node metastasis.
Discussion and Conclusion
A multidisciplinary approach should be recommended to establish an optimized treatment strategy, minimize the risk of complications, and obtain excellent oncologic outcomes via patienttailored treatment in patients with early colon cancer.

Keyword

Colonic neoplasms; Lymph nodes; Endoscopic mucosal resection; Minimally invasive surgical procedures; Laparoscopy; 대장암; 림프절; 내시경점막절제; 최소 침습 수술; 복강경