Endoscopic submucosal dissection and surgical treatment for gastrointestinal cancer

Table 1 Histological criteria for curative endoscopic resection for gastric cancer

Factors associated with no risk of lymph node metastasis

Intestinal-type histology

No lymphatic or vascular infiltration

Intramucosal cancer, regardless of tumor size, without ulcer findings

or intramucosal cancer less than 30 mm in size with ulcer findings

or minute submucosal invasive cancer (SM1) less than 30 mm in size

Factors associated with the resection margin

Tumor-free horizontal margin

Tumor-free vertical margin

Table 2 Factors for which additional treatment after endoscopic submucosal dissection should be recommended

Esophagus (squamous cell carcinoma)

Tumors in contact with or invading the muscularis mucosa

Tumors invading the submucosal layer

Stomach

Positive lateral margins

Deep submucosal invasion, regardless of positive vertical margins

(> 500 μm)

Vascular or lymphatic invasion

Diffuse-type histology

Colon and rectum

Positive vertical margins at the site of submucosal invasion

Depth of submucosal invasion greater than 1000 μm

Vascular or lymphatic invasion

Poorly differentiated adenocarcinoma, signet ring cell carcinoma, or

mucinous carcinoma

High-grade tumor budding1

¹Tumor budding: An isolated single cell or a cluster composed of fewer than five cancer cells in the stroma of the actively invasive region.