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Revisiones en Cáncer 00123 / http://dx.doi.org/10.20960/revcancer.00123

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Revisión

Lesiones premalignas y cáncer colorrectal en estadio inicial: selección del paciente y técnicas de resección local y mínimamente invasivas

Danilo Vinci, Gianluca Pellino, Eloy Espín-Basany

Prepublicado: 2026-01-14

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El desarrollo del cáncer colorrectal esporádico se basa en una progresión lenta, desde adenomas o lesiones precancerosas hasta carcinomas invasivos. Los sistemas adecuados de cribado oncológico permiten la detección de dichas lesiones y de cánceres colorrectales en estadios iniciales, que en algunos casos son susceptibles de tratamiento local. Según el estadio o la clasificación en el momento del diagnóstico, el tratamiento puede incluir la resección local, la cirugía y/o tratamientos adyuvantes o neoadyuvantes. También puede emplearse una combinación de técnicas endoscópicas y quirúrgicas avanzadas. Esta revisión ofrece una visión general de los sistemas de clasificación, de las vías diagnósticas y de las modalidades de tratamiento para pacientes con lesiones precancerosas o cáncer colorrectal en estadio inicial.

Palabras Clave: Lesiones colorrectales precancerosas. Cáncer colorrectal en estadio inicial. Resección local. ESD. EMR. TAMIS.

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Elmadani M, Mokaya PO, Omer AAA, et al. Cancer burden in Europe: a systematic analysis of the GLOBOCAN database (2022). BMC Cancer 2025;25:447.
DOI: 10.1186/s12885-025-13862-1

Helsingen LM, Kalager M. Colorectal cancer screening—approach, evidence, and future directions. NEJM Evidence 2022;1(7):EVIDra2100035.
DOI: 10.1056/EVIDra2100035

Batts KP, Cinnor B, Kim A, et al. Sessile Serrated Adenoma with Dysplasia of the Colon: A Retrospective Pathology Review Focusing on Subtypes. Am J Clin Pathol 2022;157(2):180-95.
DOI: 10.1093/ajcp/aqab112

Cancer.org. Colorectal cancer stages. Disponible en: https://www.cancer.org/cancer/types/colon-rectal-cancer/detection-diagnosis-staging/staged.html accessed on 09/11/2025

Endoscopic Classification Review Group. Update on the Paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy 2005;37(6):570-8.
DOI: 10.1055/s-2005-861352

Li M, Ali SM, Umm-a-OmarahGilani S, et al. Kudo’s pit pattern classification for colorectal neoplasms: a meta-analysis. World J Gastroenterol 2014;20(35):12649-56.
DOI: 10.3748/wjg.v20.i35.12649

Hayashi N, Tanaka S, Hewett DG, et al. Endoscopic prediction of deep submucosal invasive carcinoma: validation of the narrow-band imaging international colorectal endoscopic (NICE) classification. Gastrointest Endosc 2013;78(4):625-32.
DOI: 10.1016/j.gie.2013.04.185

Komeda Y, Kashida H, Sakurai T, et al. Magnifying Narrow Band Imaging (NBI) for the Diagnosis of Localized Colorectal Lesions Using the Japan NBI Expert Team (JNET) Classification. Oncology 2017;93(Suppl.1):49-54.
DOI: 10.1159/000481230

Rex DK, Boland CR, Dominitz JA, et al. Colorectal cancer screening: Recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2017;153(1):307-23.
DOI: 10.1053/j.gastro.2017.05.013

East JE, Atkin WS, Bateman AC, et al. British Society of Gastroenterology position statement on serrated polyps in the colon and rectum. Gut 2017;66(7):1181-96.
DOI: 10.1136/gutjnl-2017-314005

Moss A, Williams SJ, Hourigan LF, et al. Tattooing of colonic lesions: Is it necessary and how should it be done? Gastrointest Endosc 2011;74(3):640-7.

Cho YB, Lee WY, Yun HR, et al. Localization of early colorectal carcinoma using preoperative tattooing and intraoperative colonoscopy. World J Surg 2007;31(3):578-82.

Rex DK, Hassan C, Dewitt JM. Colorectal endoscopic submucosal dissection in the United States: Training, practice, and efficacy. Gastrointest Endosc 2019;90(6):972-80.

Burling D, Taylor SA, Halligan S, et al. CT colonography: Indications and clinical applications. Clin Radiol 2008;63(3):241-54.

Benson AB, Venook AP, Al-Hawary MM, et al. NCCN Guidelines Insights: Colon Cancer, Version 2.2018. J Natl Compr Canc Netw 2018;16(4):359-69.
DOI: 10.6004/jnccn.2018.0021

Dighe S, Purkayastha S, Swift I, et al. Diagnostic precision of CT in local staging of colon cancers: A meta-analysis. Clin Radiol 2010;65(9):708-19.
DOI: 10.1016/j.crad.2010.01.024

Vreugdenburg TD, Ma N, Duncan JK, et al. Comparative diagnostic accuracy of multi-detector CT and MRI for assessing colorectal liver metastases: Systematic review and meta-analysis. Eur J Radiol 2016;85(5):1027-36.

Patel CN, Gold PJ, Hope TA, et al. PET/CT in colorectal cancer: State-of-the-art review. Abdom Radiol (NY) 2021;46(4):1542-56.

Taylor SA, Mallett S, Beare S, et al. Diagnostic accuracy of CT in assessing locally advanced colon cancer: Systematic review and meta-analysis. Eur Radiol 2018;28(10):4332-43.

West NP, Hohenberger W, Weber K, et al. Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol 2010;28(2):272-8.
DOI: 10.1200/JCO.2009.24.1448

Sica GS, Anania G, Fiorani C, et al; RroC-STAR Collaborative Group. Standardization of the surgical technique and reporting for radical right colectomy with central vascular ligation and complete mesocolic excision (RroC-STAR): Delphi consensus. BJS Open 2025;9(3):zraf066.
DOI: 10.1093/bjsopen/zraf066

Sica GS, Vinci D, Siragusa L, et al. Definition and reporting of lymphadenectomy and complete mesocolic excision for radical right colectomy: a systematic review. Surg Endosc 2023;37:846-61.
DOI: 10.1007/s00464-022-09548-5

Beets-Tan RGH, Lambregts DMJ, Maas M, et al. Magnetic resonance imaging for the clinical management of rectal cancer: Updated recommendations from the 2016 ESGAR consensus meeting. Eur Radiol 2018;28(4):1465-75.
DOI: 10.1007/s00330-017-5026-2

Taylor FG, Quirke P, Heald RJ, et al. Preoperative high-resolution magnetic resonance imaging can identify good-prognosis stage I–III rectal cancer best managed by surgery alone. Ann Surg 2011;253(4):711-9.
DOI: 10.1097/SLA.0b013e31820b8d52

Brown G, Richards CJ, Bourne MW, et al. Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging. Radiology 2003;227(2):371-7.
DOI: 10.1148/radiol.2272011747

MERCURY Study Group. Extramural depth of tumor invasion at thin-section MR imaging correlated with histopathology: Results of the MERCURY Study. Radiology 2007;243(1):132-9.
DOI: 10.1148/radiol.2431051825

Smith NJ, Barbachano Y, Norman AR, et al. Prognostic significance of magnetic resonance imaging-detected extramural vascular invasion in rectal cancer. Br J Surg 2008;95(2):229-36.
DOI: 10.1002/bjs.5917

Habr-Gama A, São Julião GP, Gama-Rodrigues J, et al. Endorectal ultrasound and magnetic resonance imaging for staging rectal cancer. Clin Colon Rectal Surg 2017;30(5):306-14.

Marusch F, Koch A, Schmidt U, et al. Routine use of transrectal ultrasound in rectal carcinoma: Results of a prospective multicenter study. Dis Colon Rectum 2002;45(9):1185-93.
DOI: 10.1055/s-2002-25292

Balyasnikova S, Brown G. Imaging advances in rectal cancer. Curr Colorectal Cancer Rep 2016;12(1):42-9.

Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004;351(17):1731-40.
DOI: 10.1056/NEJMoa040694

Raju GS, Ahmed I, Xiao SY, et al. Endoscopic tattooing for colorectal lesions: Impact, standardization, and complications. Gastrointest Endosc Clin N Am 2015;25(2):231-42.

Shatz BA, Weinstock LB, Swanson PE, et al. Long-term safety of India ink tattoos in the colon. Gastrointest Endosc 1997;45(2):153-6.
DOI: 10.1016/S0016-5107(97)70239-6

Clifford RE, Fowler AL, Bland M, et al. The impact of preoperative endoscopic tattooing on mesorectal dissection and pathologic assessment in rectal cancer. Colorectal Dis 2016;18(11):O397-O404.

McCarty TR, Bazarbashi AN, Hathorn KE, et al. Endoscopic tattooing in the colorectum: An analysis of safety and outcomes. Endosc Int Open 2020;8(5):E694-E701.

Von Rahden BHA, Feussner H, Kaehler G. Carbon ink in the mesorectum mimicking local recurrence after rectal cancer surgery: Case report and literature review. Surg Endosc 2006;20(10):1690-3.

Ricci C, Pagano N, Taffurelli G, et al. Extramural spread of India ink mimicking nodal disease after rectal tattooing. Tech Coloproctol 2018;22(12):951-4.

Saito Y, Uraoka T, Matsuda T, et al. A pilot study of the safety and efficacy of endoscopic tattooing using a novel biocompatible carbon particle solution. Endoscopy 2008;40(11):1025-9.

Gachabayov M, Bergamaschi R. Endoscopic tattooing in colorectal surgery: A review. Surg Laparosc Endosc Percutan Tech 2018;28(5):313-8.

Bosch SL, Teerenstra S, De Wilt JHW, et al. Predicting lymph node metastasis in pT1 colorectal cancer: A systematic review of risk factors. J Clin Pathol 2013;66(11):951-7.

Backes Y, Seerden TCJ, Van Gestel R, et al. Risk for incomplete resection after endoscopic removal of T1 colorectal cancer: A multicenter cohort study. Gastroenterology 2017;152(3):660-72.

Rönnow CF, Arthursson V, Toth E, et al. Outcome after endoscopic resection of T1 colorectal cancer: A nationwide Swedish study. Gastroenterology 2020;159(1):179-88.e1.

Haggitt RC, Glotzbach RE, Soffer EE, et al. Prognostic factors in colorectal carcinomas arising in adenomas. Gastroenterology 1985;89(2):328-36.
DOI: 10.1016/0016-5085(85)90333-6

Kitajima K, Fujimori T, Fujii S, et al. Correlations between lymph node metastasis and depth of submucosal invasion in early colorectal carcinoma. Cancer 2004;100(8):1721-6.

Kikuchi R, Takano M, Takagi K, et al. Management of early invasive colorectal cancer: Risk of recurrence and clinical guidelines. Dis Colon Rectum 1995;38(12):1286-95.
DOI: 10.1007/BF02049154

Ueno H, Mochizuki H, Hashiguchi Y, et al. Risk factors for lymph node metastasis in early invasive colorectal carcinoma. Dis Colon Rectum 2004;47(10):1689-97.

Bosch SL, Nagtegaal ID. Pathology of early colorectal cancer: Definition of risk categories for optimal treatment. Histopathology 2020;76(1):136-48.

Egashira Y, Yoshida T, Hirata I, et al. Poorly differentiated adenocarcinoma as a predictive factor for lymph node metastasis. Dis Colon Rectum 2001;44(10):1672-8.

Hassan C, Zullo A, Risio M, et al. Histologic risk factors and clinical outcome in malignant colorectal polyps. Dis Colon Rectum 2005;48(8):1588-96.
DOI: 10.1007/s10350-005-0063-3

Rogers AC, Winter DC, Heeney A, et al. Systematic review and meta-analysis of tumor budding as a predictor of outcome in colorectal cancer. Br J Cancer 2016;115(7):831-40.
DOI: 10.1038/bjc.2016.274

Backes Y, Elias SG, et al. Margin status and risk of residual disease after local excision of T1 colorectal cancer. Gastrointest Endosc 2018;87(4):1180-9.

Watanabe T, Itabashi M, Shimada Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines 2019 for the Treatment of Colorectal Cancer. Int J Clin Oncol 2020;25(1):1-42.
DOI: 10.1007/s10147-019-01485-z

Ferlitsch M, Moss A, Hassan C, et al. Colorectal polypectomy and endoscopic mucosal resection (ESGE Guideline). Endoscopy 2017;49(3):270-97.
DOI: 10.1055/s-0043-102569

Ricciardiello L, Hassan C, Lauriola M, et al. Clinical and pathological features predicting lymph node metastasis in T1 colorectal carcinoma: An Italian multicenter study. Dig Liver Dis 2017;49(5):471-6.

Ueno H, Hashiguchi Y, et al. Indicators of curative endoscopic resection for T1 colorectal cancer: A multicenter study of the Japanese Society for Cancer of the Colon and Rectum. Dis Colon Rectum 2018;61(8):904-13.

Bourke MJ, Neuhaus H, Bergman JJGHM. Endoscopic resection of colorectal laterally spreading lesions. Gastroenterology 2020;158(2):458-76.

Kaltenbach T, Anderson JC, Burke CA, et al. Endoscopic removal of colorectal lesions-Recommendations from the US Multi-Society Task Force. Gastroenterology 2020;158(4):1095-129.
DOI: 10.1053/j.gastro.2019.12.018

Tanaka S, Kashida H, Saito Y, et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc 2015;27(4):417-34.
DOI: 10.1111/den.12456

Fuccio L, Hassan C, Ponchon T, et al. Colorectal ESD: systematic review & meta-analysis. Gut 2017;66(4):668-76.

Sano Y, Tanaka S, Kudo S-E, et al. NICE classification. Endoscopy 2016;48(10):939-52.

Schmidt A, Beyna T, Schumacher B, et al. Colonoscopic full-thickness resection using an over-the-scope device: a prospective multicentre study in various indications. Gut 2018;67(7):1280-9.
DOI: 10.1136/gutjnl-2016-313677

Facciorusso A, Antonino M, Di Maso M, et al. Endoscopic full-thickness resection of colorectal lesions: a systematic review and meta-analysis. Gastrointest Endosc 2020;91(6):1189-201.e3.
DOI: 10.1016/j.gie.2020.03.2908

Saito Y, Abe S, Nakajima T, et al. Colorectal endoscopic submucosal dissection: technical advantages compared to EMR and EFTR limitations. Endoscopy 2022;54(8):729-42.

Schmidt A, Riecken B, Damm M, et al. Performance of endoscopic full-thickness resection (EFTR) in fibrotic non-lifting colorectal lesions: results from the German EFTR registry. Endoscopy 2019;51(10):1021-8.

Rex DK, Vemulapalli KC, Uedo N, et al. Endoscopic full-thickness resection (EFTR): technical review from the ASGE Endoscopy Innovation Task Force. Gastrointest Endosc 2021;93(2):316-31.

Bronzwaer MES, Bastiaansen BAJ, Koens L, et al. Endoscopic full-thickness resection of difficult colorectal polyps with the full-thickness resection device (FTRD): multicentre experience. Endoscopy 2020;52(6):471-8.

Buess G, Theiss R, Hutterer F, et al. Transanal endoscopic microsurgery for removal of rectal tumors. Surg Endosc 1988;2(4):245-51.
DOI: 10.1007/BF00705331

Atallah S, Albert M, Larach S. Transanal minimally invasive surgery: a giant leap forward. Surg Endosc 2010;24(9):2200-5.
DOI: 10.1007/s00464-010-0927-z

De Graaf EJR, Doornebosch PG, et al. Transanal endoscopic microsurgery for T1 rectal cancer: risk factors for local recurrence and endoscopic follow-up. Colorectal Dis 2011;13(8):882-7.

Lee L, Burke JP, De Beaumont J, et al. A systematic review of transanal endoscopic microsurgery and TAMIS for early rectal cancer. Dis Colon Rectum 2018;61(7):761-74.

Sylla P, et al. Current management of early rectal cancer: local excision and transanal approaches. Clin Colon Rectal Surg 2021;34(5):287-97.

Atallah S, Albert M, Larach S, et al. TAMIS versus TEM: comparison of short-term outcomes. Surg Endosc 2013;27(9):3457-62.

Dekkers N, Verhoeven D, Boonstra JJ, et al. Multicenter, randomized non-inferiority trial comparing transanal minimally invasive surgery (TAMIS) and endoscopic submucosal dissection (ESD) for resection of non-pedunculated rectal lesions (TRIASSIC Study). Presented at: Improving Decision-Making in Colorectal Lesions; October 5, 2025. Netherlands.

Beaton C, Twine CP, Williams GL, et al. Systematic review and meta-analysis of histopathological factors influencing risk of lymph node metastasis in early colorectal cancer. Br J Surg 2013;15(7):788-07.
DOI: 10.1111/codi.12129

Shinto E et al. Histological prognostic factors for T1 colorectal cancer with lymph node metastasis. Dis Colon Rectum 2014;57(5):611-8.

Nascimbeni R, Burgart LJ, Nivatvongs S, et al. Risk of lymph node metastasis in T1 carcinoma of the colon and rectum. Dis Colon Rectum 2002;45(2):200-6.
DOI: 10.1007/s10350-004-6147-7

Sohn DK et al. Multi-factor risk model for predicting lymph node metastasis in T1 colorectal cancer. J Gastrointest Surg 2018;22(4):726-33.

Serra-Aracil X, Gil-Barrionuevo E, Martínez E, et al. Combined endoscopic and laparoscopic surgery for the treatment of complex benign colonic polyps (CELS): Observational study. Cir Esp (Engl Ed) 2022;100(4):215-22.
DOI: 10.1016/j.ciresp.2020.12.013

Van Marle L, Hanevelt J, De Vos Tot Nederveen Cappel WH, et al. Colonoscopic-assisted laparoscopic wedge resection for colonic neoplasms: a systematic review. Scand J Gastroenterol 2024;59(7):808-15.
DOI: 10.1080/00365521.2024.2349645