Endoscopy 2020; 52(S 01): S43-S44
DOI: 10.1055/s-0040-1704134
ESGE Days 2020 oral presentations
Thursday, April 23, 2020 10:30 – 12:00 Innocent & guilty polyps Wicklow Meeting Room 3
© Georg Thieme Verlag KG Stuttgart · New York

RESULTS OF ADDITIONAL SURGERY AFTER ENDOSCOPIC RESECTION FOR T1 COLORECTAL CANCER IN A FRENCH MULTICENTER COHORT

F Corre
1   Cochin University Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Gastroenterology, Paris, France
,
M Barret
1   Cochin University Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Gastroenterology, Paris, France
,
JP Ratone
2   Paoli Calmettes Institute, Gastroenterology, Marseille, France
,
J Albouys
3   Limoges University Hospital, Gastroenterology, Limoges, France
,
G Rahmi
4   Georges Pompidou University Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Gastroenterology, Paris, France
,
E Chabrun
5   Haut-Lévêque University Hospital, Gastroenterology, Bordeaux, France
,
JM Canard
6   Trocadero Clinic, Gastroenterology, Paris, France
,
M Camus
7   Saint-Antoine University Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Gastroenterology, Paris, France
,
T Wallenhorst
8   Rennes University Hospital, Gastroenterology, Rennes, France
,
D Karsenti
9   Bercy Clinic, Gastroenterology, Paris, France
,
M François
10   Nancy University Hospital, Gastroenterology, Nancy, France
,
R Gerard
11   Lille University Hospital, Gastroenterology, Lille, France
,
J Jacques
3   Limoges University Hospital, Gastroenterology, Limoges, France
,
B Terris
12   Cochin University Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Pathology, Paris, France
,
R Coriat
1   Cochin University Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Gastroenterology, Paris, France
,
S Chaussade
1   Cochin University Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Gastroenterology, Paris, France
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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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.