[Endoscopic Therapy of Early XXXX ( @entity2558 ) - A Prospective Study].

@entity1 @entity2558 @entity1127 @entity5 @entity189 @entity3 @entity14
INTRODUCTION: In a prospective study initiated in 1982, we have been investigating the question as to whether - and if so, which - @entity2558 @entity189 of the colorectum can be treated exclusively via the endoscope. METHOD: In the period between February 1, 1982 and April 30, 2001, a total of 5,470 @entity1127 were removed endoscopically at the Medical Department I of the Klinikum Ludwigsburg. Among these lesions, a total of 144 (2.6 %) @entity2558 @entity189 were found in 141 @entity1 . We were able to follow 120 @entity1 with 123 @entity2558 @entity189 over a mean follow-up period of 46 months (range: 1-60). In low-risk situations (definitive removal in healthy tissue, G1-G2, no lymphatic involvement), endoscopic treatment alone usually represented sufficient treatment. In high-risk cases (removal in healthy tissue uncertain or negative, and/or lymphatic vessel involvement, and/or G3/G4), subsequent surgical resection was carried out. RESULTS: 64 cases were classified as high-risk, 59 as low-risk. Nevertheless, 9 @entity1 with 10 @entity189 were submitted to surgery (young age, @entity1 's own request). In none of these 10 cases was @entity5 or lymph node @entity3 detected in the surgical specimen. 47 @entity1 with 49 @entity189 were treated solely by endoscopic polypectomy using the diathermy snare, and 45 @entity1 with 47 @entity189 remained recurrence-free during the follow-up period. In a single case, a local recurrence was detected 2 months after polypectomy and underwent curative resection. In another case, peritoneal carcinosis with @entity5 infiltrating into the colon developed 8 months after initial treatment; this, however, was most probably a recurrence of a previously operated @entity189 . Among the high-risk cases, 10 were not submitted to surgery on account of advanced age and/or rejection of an operation by the @entity1 ; all remained recurrence-free. Among the surgically treated high-risk @entity189 , 3 surgical specimens contained @entity5 , while 2 revealed a lymph node @entity3 . In our group of @entity1 , no @entity5 -related mortality was seen among endoscopically treated @entity1 . DISCUSSION: In the light of the fact that the reported mortality rate associated with open surgery for @entity14 is 3 % as compared with about 1 % risk of lymph node @entity3 and 0,1 % mortality rate for the endoscopic modality, endoscopic removal of a @entity2558 @entity5 in a low-risk situation followed by appropriate surveillance can be considered as adequate treatment.
