Early colorectal cancer diagnosed after endoscopic resection: Conservative treatment is safe in most of the cases. Proposal for a risk-based management

• Published in: Cirugia española (English ed.) 2022-10, Vol.100 (10), p.635-640
• Main Authors: Sancho-Muriel, Jorge, Pellino, Gianluca, Cholewa, Hanna, Giner, Francisco, Bustamante-Balén, Marco, Montesarchio, Luca, García-Granero, Eduardo, Frasson, Matteo
• Format: Article
• Language: English
• ISSN: 2173-5077; 2173-5077
• DOI: 10.1016/j.cireng.2022.08.018

INTRODUCTIONEndoscopic resection offers advantages over surgical resection for early colorectal cancer (ECC). However, there might be a presumed risk of recurrence. We aimed to determine the risk of recurrence after endoscopic removal of ECC. METHODSA single-centre series of endoscopic resections for ECC. Patients were stratified according to four risk factors: positive resection margins, Haggitt 4, lymphatic/vascular invasion and tumour budding. RESULTSWe included 127 patients. Haggitt classification was grade 4 in 54.0%. Positive margins were found in 43 (33.9%), 16 (12.6%) had lymphatic or vascular invasion, and 5 (4.0%) had high grade budding. In 82 (64.5%) endoscopic excision was the definitive treatment, 45 (35.4%) underwent surgery. Six patients (13.3%) had residual tumour on specimen and/or node metastases. Postoperative complications occurred in ten (22.2%). At a median follow-up of 63 months, none of the 82 patients treated with endoscopic resection alone had recurrence. After stratifying patients according to risk factors, those who had residual tumour also had ≥2 risk factors. CONCLUSIONSEndoscopic follow up might be a valid option for patients with ECC. A risk-adjusted management seems prudent.