Multidisciplinary Approach Strategy for the Management of T1 Colorectal Cancer: Oncological Outcomes Following Endoscopic and Surgical Resections

Aims The optimal management of T1 colorectal cancer (CRC) remains a subject of debate in the West, with significant variability in treatment strategies and long-term oncological outcomes. This study aimed to evaluate the oncological outcomes of high-risk (HR) and low-risk (LR) T1 CRC patients treated with up-front surgery (US), endoscopic resection (ER), or ER followed by US (ER+S) [1].

Methods We enrolled all consecutive T1 CRC cases treated between 2014 and 2020 at a high-volume colorectal cancer center. The most appropriate treatment strategy was chosen considering comorbidities, performance status, and personal preferences. Patients were classified as either high-risk (HR) or low-risk (LR) based on histological features. In order to directly compare, the same criteria were also evaluated the US group. The US and ER+S were evaluated together for histologic features associated with lymph nodes metastasis (N+). ER+S was also evaluated for residual cancer on surgical samples. Rectal cancer treated with TAMIS were not evaluated for lymph nodes and were considered as part of ER group in the evaluation of long term outcomes. The oncological outcomes evaluated were: unfavourable outcome (recurrence and/or N+), recurrences, N+, cancer-related death rates and residual cancer on surgical specimen.

Results Out of 326 T1 CRC patients analyzed: 96 (29.4%) underwent US; 76 (23.3%) underwent ER; and 154 (47.3%) underwent ER+US. The rates of HR were respectively 39/96 patients (40.6%) in US group, 42/76 patients (55.3%) in ER group and 134/154 (87.0%) in ER+S group. Residual cancer, recurrences, lymph nodes metastasis and cancer-related death were observed only in HR groups, for both rectal and not-rectal cancer. High tumor budding grade (Bd2-3) in rectal lesions was associated with unfavourable outcome [OR 4.12, 95% CI (1.28-12.27), p=0.011], lymph nodes metastasis [OR 4.60, 95% CI(1.35-15.70), p=0.015] and residual cancer [OR 6.0, 95% CI (1.65-21.74), p=0.006]. Poor differentiation was associated in rectal lesion with unfavorable outocome [OR 4.84, 95% CI (1.60-14.70), p=0.005] and N+[OR 4.08, 95% CI (1.21-13.69), p=0.023]. No statistically significant difference in term of recurrence were observed among the study groups and no association was found with histologic high risk features. Cancer-related death occurred in 1/96 (1.04%) of cases in US group, while there were no cancer-related deaths after ER or ER+S.

Conclusions Oncological outcomes for T1 CRCs are comparable across treatment modalities. Low-risk patients showed uniformly excellent outcomes, supporting less invasive approaches, such as ER. A tailored, multidisciplinary strategy remains essential for optimizing management of HR patients.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

• 1 Rönnow CF, Arthursson V, Toth E, Krarup PM, Syk I, Thorlacius H.. 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 2022; 275 (1): e148-e154