The Choice of an Endoscopic Resection or a Surgical Resection Based on the Surgical Cases of Early Rectal Cancer

Preserving defection, urination and sexual functions while maintaining radicality is a point which must be considered in choosing endoscopic versus surgical resection in early rectal cancer. The exact diagnosis of the depth of invasion is the msot important point in selecting the appropriate treatment. Detecting vascular invasion is essential determining whether minimally invasive, reduction surgery is feasible. The ratio of lymph node metastasis in early rectal cancer was 4.8% in sml cases and 19.3% in sm2, 3 cases. When we divided the cases into vascular invasion (-) and vascular invasion (+) groups, there was a significant difference between the ratios of lymph node metastasis (the former-0.0% and the later-2.6%). In order to avoid rectal amputation for lesions of the lower part of the rectum (P and Rb near by P), treatment selection should be based strictly and precisely on determination of the depth of invasion and the existence of vascular invasion as revealed in samples obtained by endoscopic or local resection. The ratio of lymph node metastasis was extremely low in sm2, 3 cases without vascular invasion, and in smi cases. Therefore, endoscopic or local resection is feasible in most of these cases, such that rectal amputation can be avoided. In cases requiring extensive and lymph node dissection, D1 lymph node dissection (upper side D2 and lateral side D1) is preferred over D2 or D3 dissection, because all cases with lymph node metastasis were n1 (+). We consider this to be the only treatment which guarantees full preservation of autonomic function.