Considerable practice variation in use of pathological high-risk T1-CRC criteria: Why, and how to do better?

Although intramucosal adenocarcinomas are most often not considered T1 colorectal cancers (T1-CRC) in European series [1], they are, nonetheless, cancerous tumors (T1a) owing to invasion into the chorion, and are considered as such by Japanese endoscopists. These lesions have no or negligible risk of lymph node metastasis and most Western endoscopists consider piecemeal endoscopic mucosal resection (EMR) suitable for them, dismissing the need for tumor-free resection margins. However, comparative data to evaluate the risk of missed information induced by piecemeal resection [2], including focal submucosal invasion, are still lacking. This underlines the discordance in the definition of malignant lesions that are present from the very first stage and that also exist at more advanced stages.

Publication History

Article published online:
07 October 2020

• References

• 1 Backes Y, Schwartz MP, Ter Borg F. et al. Multicentre prospective evaluation of real-time optical diagnosis of T1 colorectal cancer in large non-pedunculated colorectal polyps using narrow band imaging (the OPTICAL study). Gut 2019; 68: 271-279
• 2 Pioche M, Rivory JJ, Ter Borg F. et al. Colorectal endoscopic submucosal dissection for all LSTs: histological information loss due to piecemeal EMR is no longer acceptable. Endosc Int Open 2019; 7: E1195-E1196
• 3 Gijsbers K, de graaf W, Moons L. et al. High practice variation in risk stratification, baseline oncological staging and surveillance strategies for T1 colorectal cancers in the Netherlands. Endosc Int Open 2020; E1117-E1122
• 4 Yim K, Won DD, Lee IK. et al. Novel predictors for lymph node metastasis in submucosal invasive colorectal carcinoma. World J Gastroenterol 2017; 23: 5936 ers i
• 5 Yasue C, Chino A, Takamatsu M. et al. Pathological risk factors and predictive endoscopic factors for lymph node metastasis of T1 colorectal cancer: a single-center study of 846 lesions. J Gastroenterol 2019; 54: 708-717
• 6 Patel N, Vyas M, Celli R. et al. Adverse histologic features in colorectal nonpedunculated malignant polyps with nodal metastasis. Am J Surg Pathol 2020; 44: 241-246
• 7 Rönnow C-F, Arthursson V, Toth E. et al. Lymphovascular Infiltration, not depth of invasion, is the critical risk factor of metastases in early colorectal cancer: retrospective population-based cohort study on prospectively collected data, including validation. Ann Surg 2020; 13
• 8 Suh JH, Han KS, Kim BC. et al. Predictors for lymph node metastasis in T1 colorectal cancer. Endoscopy 2012; 44: 590-595
• 9 Beaton C, Twine CP, Williams GL. et al. Systematic review and meta-analysis of histopathological factors influencing the risk of lymph node metastasis in early colorectal cancer. Colorectal Dis Off J Assoc Coloproctology G B Irel 2013; 15: 788788y
• 10 Ozawa H, Kotake K, Ike H. et al. Prognostic Impact of the Length of the Distal Resection Margin in Rectosigmoid Cancer: An Analysis of the JSCCR Database between 1995 and 2004. J Anus Rectum Colon 2020; 4: 59-66