Endoscopic Submucosal Dissection for Colorectal Cancer with Suspected Deep Submucosal Invasion
10.52927/jdcr.2026.14.1.26
- Author:
Jae Hyun KIM
1
Author Information
1. Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
- Publication Type:REVIEW ARTICLE
- From:
Journal of Digestive Cancer Research
2026;14(1):26-32
- CountryRepublic of Korea
- Language:English
-
Abstract:
The optimal management of T1 colorectal cancer with suspected submucosal (SM) invasion remains controversial. Although deep SM invasion (≥ 1,000 μm) is traditionally regarded as an indication for radical surgery owing to the risk of lymph node metastasis, emerging evidence suggests that invasion depth alone is insufficient for treatment decision-making. This review aimed to evaluate the role of endoscopic SM dissection (ESD) in colorectal cancer with suspected SM invasion, focusing on indications, limitations, and oncologic outcomes. A narrative review of current guidelines and published literature was conducted to evaluate pathologic risk factors, surgical and organ-preservation strategies, and technical outcomes of ESD in lesions with suspected deep SM invasion. Institutional cohort data were also summarized to illustrate real-world clinical application. Recent evidence highlights the importance of composite pathologic risk factors, such as lymphovascular invasion, tumor budding, and resection margin status, over invasion depth alone in predicting lymph node metastasis. ESD enables en bloc resection and precise histopathologic assessment, which facilitates stepwise treatment planning. However, achieving vertical margin clearance may be technically challenging in lesions with deep SM invasion. Accumulating data from surgical and organ-preservation approaches support a risk-adapted strategy rather than routine radical resection, particularly in selected patients with high surgical risk. In colorectal cancer with suspected SM invasion, ESD serves as a valuable diagnostic and therapeutic modality that informs individualized treatment decisions. Management should be based on comprehensive pathologic risk assessment and patientspecific factors rather on than invasion depth alone.
