Impact of multidisciplinary team meeting presentation of superficial GI tumors resected by endoscopy: a retrospective study

Aims Diagnostic and therapeutic endoscopy has developed considerably in recent years, enabling characterization of superficial GI tumors, and minimally invasive resection when indicated. Histological analysis enables endoscopically resected T1 lesions to be classified as tumors at high or low risk of lymph node metastases. The European Society of Gastrointestinal Endoscopy (ESGE) recommends the discussion of endoscopically resected superficial GI tumors in a multidisciplinary team meeting (MDTm), but few studies have assessed the impact. Our main objective was to evaluate the change in status (high/low risk) of endoscopically resected superficial GI tumors after pathological review at the MDTm.

Methods This observational, retrospective study reviewed data from the regional organization centralizing MDTm reports and a specialized cancer registry. All consecutive patients who had endoscopic resection of a superficial epithelial GI tumor presented in MDTm between January 2018 and December 2022 in a French province were included. Histological criteria from the first analysis and expert review were collected.

Results 187 patients were presented in MDTm during the study period. 151 patients were included, including 29 patients (19%) with a superficial esophageal tumor, 2 (1.3%) with a gastric tumor, 1 (0.7%) with a duodenal tumor and 119 (79%) with a colorectal tumor, i.e. 46% of T1 colonic tumors resected endoscopically during tis period. Histological review by an expert pathologist led to a change in at least one histological criterion in 24% of patients. In particular, 15 (10%) changes in emboli status and 8 (6%) changes in budding status were recorded. A total of 9.5% of patients had a change in risk status, with 7 patients moving from high-risk to low-risk status and 6 patients from high-risk to low-risk status. Of these patients, 6 underwent surgery and 2 had tumor residue or lymph node metastasis. The ESGE recommendations for the management of superficial GI tumors were followed by 92% of patients. The MDTm decision was followed by 98% of gastroenterologists and patients. Fifteen patients with superficial esophageal tumors received additional treatment, mainly radiotherapy (n=7, 37%) and chemotherapy (n=5, 26%). Of the 4 patients operated on, only one had tumor residue on the surgical specimen, and none had lymph node metastasis. Among patients with superficial colorectal tumors, 64 underwent further treatment, with 62 (82%) managed surgically. Of these, 10 had local tumor residue and 12 lymph node metastases on the surgical specimen, i.e. 15 (23%) patients with residue, lymph node metastasis or both.

Conclusions Review by an expert pathologist most often reinforced the decision for further treatment, sometimes highlighting pejorative criteria not seen on first reading. In almost 10% of cases, this re-reading changed the risk level of a lesion, with a direct impact on management. The ESGE recommendations were followed by 92% of gastroenterologists, demonstrating their real-life application.

Publication History

Article published online:
27 March 2025