Should we be less concerned about T1 colorectal cancers developed on pedunculated polyps? A 12-year retrospective population-based study

Aims A significant number of T1 colorectal cancers (T1 CRCs) are pedunculated CRCs resected by non-expert gastroenterologists. The identification of pejorative histological prognostic criteria for lymph node metastasis (LNM) leads to further treatment, mainly surgery. Recent data suggest that pedunculated T1 CRCs have a better prognosis than non-pedunculated ones. The aim of this study was to describe the long-term prognosis of endoscopically resected T1 CRCs, and in particular pedunculated T1 CRCs.

Methods This retrospective study included all patients with endoscopically resected T1 adenocarcinoma between January 1^st, 2009 and December 31, 2020 in a French province Patient- and tumor-specific data and long-term follow-up were collected via a specialized tumor registry. The presence of LNM or tumor residue at the resection site on the complementary surgical resection specimen was collected, as was the occurrence of local or distant recurrence during follow-up.

Results 456 patients with T1 CRC were included, of whom 254 (55.7%) corresponded to a pedunculated form. Patients with pedunculated CRC were younger (65+/- 10 years) than those with non-pedunculated CRC (69+/-10; p=0.001), with no difference in gender. Pedunculated lesions were more often located in the left colon (89%), while non-pedunculated lesions were mainly distributed between the right colon (16%), left colon (49%) and rectum (33%) (p<0.001). Resection was significantly more frequent in monobloc for pedunculated CRC (89 vs. 66%; p<0.001). Median follow-up was 40 months (Q25-Q75 18-71). After histological analysis, budding, lymphovascular invasion, poor differentiation and depth of invasion did not differ between pedunculated and non-pedunculated lesions. However, the rates of healthy lateral margins, healthy deep margins and R0 were significantly higher in pedunculated lesions (80%, 84% and 78% respectively) than in non-pedunculated lesions (58%, 66% and 52% respectively) (p<0.001). Pedunculated lesions were more often classified as low-risk (n=127/254; 50%) than non-pedunculated (n=74/202; 37%, p=0.004). Of the 262 patients operated on, 18 showed LNM, without difference between groups (p=0.6). LNM, tumor residue on the surgical specimen and recurrence was therefore present in 17 (6.7%) of patients with pedunculated lesions and 22 (11%) of non-pedunculated lesions (p=0.11). In multivariate analysis, the histo-prognostic criteria associated with the occurrence of adverse events in all lesions was lympho-vascular emboli (HR 4.37; 1-19.8; p=0.049). When only pedunculated lesions were considered, no criteria were identified, probably due to the low number of events. There was no difference in overall or recurrence-free survival between groups.

Conclusions Pedunculated T1CRCs appear to have a different risk profile, although expert pathological examination is not always available as these lesions are often not resected in expert centers.

 

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Conflicts of Interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
27 March 2025