Table 4.

Summary and Strength of Recommendations for Early Colorectal Cancer

Statement C1: Poor histologic types (poorly differentiated adenocarcinoma, signet ring cell carcinoma, and mucinous carcinoma), deep submucosal invasion, lymphovascular invasion, and intermediate-to-high–grade tumor budding at the site of deepest invasion are risk factors of lymph node metastasis in early colorectal cancer (Grade of recommendation: strong, Level of evidence: moderate).

Statement C2: Endoscopic resection of submucosal colorectal cancer with a high risk of lymph node metastasis has a higher recurrence rate than surgical resection. Therefore, we recommend additional surgery if histological signs after endoscopic resection suggest a high risk of lymph node metastasis (Grade of recommendation: strong, Level of evidence: high).

Statement C3: We recommend endoscopic assessment of pit patterns and vascular patterns to estimate the depth of submucosal invasion before endoscopic resection of early colorectal cancer (Grade of recommendation: strong, Level of evidence: high).

Statement C4: En bloc and histologically complete resection should be achieved for endoscopic treatment of a suspected or established early colorectal cancer. We recommend endoscopic submucosal dissection for the treatment of endoscopically resectable early colorectal cancer which cannot be resected en bloc using endoscopic mucosal resection technique (Grade of recommendation: strong, Level of evidence: moderate).