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DOI: 10.1055/s-0040-1704134
RESULTS OF ADDITIONAL SURGERY AFTER ENDOSCOPIC RESECTION FOR T1 COLORECTAL CANCER IN A FRENCH MULTICENTER COHORT
Publication History
Publication Date:
23 April 2020 (online)
Aims A 10% risk of lymph node involvement is associated with submucosal (T1) colorectal carcinomas treated with endoscopic resection, potentially indicating additional surgical resection. The absence of four histological features recalled in the Japanese (JSCCR) and European (ESGE) guidelines allows in case of R0 resection to avoid additional surgery. We aimed to evaluate the results of complementary surgery after endoscopic resection for a T1 colorectal cancer in a Western population.
Methods We conducted a retrospective multicenter study and included all patients who had an endoscopic mucosal resection or an endoscopic submucosal dissection for T1 colorectal cancer in eight French expert centers between March 2012 and July 2019.
Results We included 223 patients. The mean ± SD age of the population was 70.9 ± 11 years. Nearly half of the patients had an endoscopic submucosal dissection. Complementary surgery and surveillance alone were recommended in 56.4% and 43.6% of patients, respectively. Of the 73 patients who had an actual indication for additional surgery according to the ESGE guidelines, 60 (82.2%) had a pT0N0 surgical specimen. 12 (16.4%) patients had lymph node metastases: 9 had deep submucosal invasion > 2000 µm; 5 had a mucinous histology; 10 had only one pejorative histological feature. If the submucosal invasion threshold had been set to 2000 µm without any other pejorative histological feature, 7 (9.6%) surgeries could have been avoided without increasing the risk of lymph node involvement.
Conclusions Using the histological criteria recommended by the ESGE to indicate a complementary surgery after endoscopic resection for T1 colorectal cancer in a Western population leads to 82% of surgical specimens free of cancer. In this study, pushing the threshold of submucosal invasion up to 2000 µm associated with the absence of any pejorative qualitative histological feature could reduce the number of surgical indications without increasing the risk of lymph node involvement.
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