**5. The treatment of colorectal carcinoma with submucosal invasion state after endoscopic resection**

**SM depth X (µm) Ip type Non-Ip type**

0 < X < 500 10 0(0) 65 0(0)

500 ≤ X < 1000 7 0(0) 58 0(0)

1000 ≤ X < 1500 11 1(9.1)\* 52 6(11.5)

1500 ≤ X < 2000 7 1(14.3)\* 82 10(12.2)

2000 ≤ X < 2500 10 1(10.0)\* 84 13(15.3)

2500 ≤ X < 3000 4 0(0) 71 8(11.3)

3000 ≤ X < 3500 9 2(22.2) 72 5(6.9)

3500 ≤ X 30 2(6.7) 240 35(14.6)

**Table 4.** Relationship between clinicopathological factors and the rate of the lymph node metastasis according to SM

Lymph node metastasis n (%) 0 ⁄101 (0) 8 ⁄129 (6.2) 8 ⁄230 (3.5) 95% CI (%) 0.00–3.60P 2.70–11.90 1.50–6.70

Recurrence n (%) 0 ⁄219 (0) 1 ⁄121 (0.8) 1 ⁄340 (0.3) 95% CI (%) 0.00–1.70 0.02–4.50 0.01–1.60

Lymphovascular invasion†, n (%) 35 ⁄240 (15) 55 ⁄144 (38) 90 ⁄384 (23) Lymphatic invasion, n (%) 21 (9) 33 (23) 54 (14) Venous invasion, n (%) 16 (7) 37 (26) 53 (14) Poorly differentiated component, n (%) 26 ⁄240 (11) 26 ⁄144 (18) 52 ⁄384 (14)

**Table 5.** Histopathological characteristics of 384 cases of pedunculated type early invasive colorectal cancer (adapted

head invasion (X=0) 53 3(5.7)\*

168 Colonoscopy and Colorectal Cancer Screening - Future Directions

Ip type: pedunculated lesion. Non-Ip type: nonpedunculated lesion

Lymphatic and ⁄or venous invasion. CI, confidence interval

depth (summarized of Table 2 and 3, adapted from [11]. English translated version]

\*: vessels invasion

from [12])

**n pN positive (%) n pN positive (%)**

**Head invasion Stalk invasion Total**

\*P = 0.02

\*\*P = 0.72

Many new treatment methods have been developed over the last few decades. The Japanese Society for Cancer of the Colon and Rectum guidelines 2010 for the treatment of colorectal cancer (JSCCR Guidelines 2010 [13]) have been prepared to show standard treatment strat‐ egies for submucosal invasive colorectal cancer (Figure. 6).

**Figure 6.** Guide line for the treatment of colorectal carcinoma with submucosal invasion state after endoscopic resection. (adapted from JSCCR Guidelines 2010 [13] with minor modifications );; Pap: papillary adenocarcinoma, Tub: tub‐ ular adenocarcinoma, Por: poorly differentiated adenocarcinoma, Sig: signet-ring cell carcinoma, Muc: mucinous adenocarcinoma, SM: submucosal invasion, Budding: tumor budding. The tumor budding denotes that at the invasion front of colorectal adenocarcinomas tumour cells, and the potential of tumour budding as a prognostic factor (G1:Grade 1 to G3: Grade 3) for routine surgical pathology [14,15])

**Figure 7.** Endoscopic, stereomicroscopic, macroscopic findings of the early colorectal carcinoma. Endoscopic finding of the pedunculated(Non-Ip) type (a), several pits are arranged irregularly in the stereomicroscopic view (b), macroscopic appearance of SICC, post formalin-fixed. Most of the endoscopic detectable lesions were the irregular elevated type macroscopically. (White bar: mucosal invasion, Red bar: submucosal invasion) (c),

finding

finding
