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• W1966692007 abstract "Robust data to guide physicians and surgeons of when to operate on patients with sessile or (NP) T1 is absent. Current clinical practice relies on a variety of univariate and multivariate criteria aimed to define favorable prognostic factors. These criteria are, thus, difficult to apply to the individual patient. We sought to establish a simple criteria that can be used to risk stratify patients with sessile or NP T1 CRC for developing metastasis. We analyzed data of all sessile and NP T1 CRC between 1997 to 2009 that were removed by endoscopy and surgery. These lesions had been meticulously studied. We excluded data from patients with synchronous, polyposis or secondary cancer. We abstracted the long-term clinical outcomes with CT scans for endoscopy patients. We included prognostic factors that can be applied worldwide: size, location (colon vs. rectum), degree of differentiation (WHO criteria), lymphovascular involvement, and depth of invasion. We performed univariate and multivariate to identify a subset of prognostic factors, which have a zero risk for LNM. 519 T1 CRC from patients (63% male) with mean age of 63.3±10.2 years were studied. 443 lesions (85%) were surgically removed; with 15.7±8.8 lymph nodes (range1-51) dissected. 76 lesions (15%) were endoscopically resected followed by CT surveillance at a mean 3.7±2.3, range 05 to 12 years. The lesions were sessile (n=272), flat (n=215), or depressed (n=30); measured 2.2±1.5 cm (range 0.4 to 14 cm); and distributed throughout the colon (right n=174, left n=183, and rectum n=160). 515 cancers (99%) were well or moderately-well differentiated; 388 (75%) had no lymphovascular invasion. Lymph node metastasis was found in 60 of the T1 cancers (11.6%, 95%CI: 8.9-14.6%). Univariate and multivariate analyses showed that lymphovascular invasion (p<0.001) and poor differentiation (p=0.04) as significant prognostic factors. Analysis of aggregated prognostic factors into stratified criteria (Table) showed that: 1) small size cancers (≤ 1cm) have high-risk of LNM, similar to the larger ones, irrespective of depressed shape 2) superficial submucosal invasion (≤ 1000μm) has low, but not zero. risk of LNM, and 3) subset criteria with no LNM cannot be generalized due to wide confidence interval.TableManagement Criteria of T1 Colorectal CancerCriteriaIncidence of LNM95% CIAll Superficial Invasion (≤1000μm)11.6%6.0%9.5 - 15.5%2.0 - 13.5%Differentiated adenocarcinoma, no lymphatic-vascular invasion, irrespective of depth of invasion Irrespective of tumor size6.8%4.5 - 9.8% Tumor <1cm in size10.5%2.9 - 24.8% Tumor ≥1cm in size6.4%4.0 - 9.5% Tumor <2cm in size6.8%3.7 - 11.4% Tumor ≥2cm in size6.7%3.6 - 11.2%Differentiated adenocarcinoma, no lymphatic-vascular invasion, depth of invasion ≤1000μm Irrespective of tumor size5.6%1.5 - 13.6% Tumor <1cm in size16.7%2.1 - 48.4% Tumor ≥1cm in size3.3%0.4 - 11.5% Tumor <2cm in size10.0%2.8 - 23.7% Tumor ≥2cm in size0.0%0 - 10.9%Differentiated adenocarcinoma, no lymphatic-vascular invasion depth of invasion ≤1000μm, without depressed component Irrespective of tumor size6.5%1.4- 17.9% Tumor <1cm in size12.5%0.3 - 52.% Tumor ≥1cm in size5.3%0.6 - 17.7% Tumor <2cm in size6.8%2.7 - 32.4% Tumor ≥2cm in size0.0%0 - 15.4%Differentiated adenocarcinoma, no lymphatic-vascular invasion, depth of invasion ≤1000μm, with polypoid growth Irrespective of tumor size7.1%1.5 - 19.5% Tumor <1cm in size25%0.6 - 80.6% Tumor ≥1cm in size5.3%0.6 - 17.7% Tumor <2cm in size15%3.2 - 37.9% Tumor ≥2cm in size0%0 - 15.4%Differentiated adenocarcinoma, no lymphatic-vascular invasion, depth of invasion ≤1000μm, with non-polypoid growth Irrespective of tumor size3.6%0.1 - 18.3% Tumor <1cm in size11.7%0.3 - 52.7% Tumor ≥1cm in size0%0 - 16.8% Tumor <2cm in size5.0%0.1 - 24.9% Tumor ≥2cm in size0%0 - 36.9% Open table in a new tab Contrary to current clinical practice, small colorectal T1 carcinomas have an unexpected high risk for LNM; superficial submucosal invasion (≤ 1000μm) is associated with some risk of LNM, despite the lesion being well differentiation and without lymphovascular invasion; and criteria with zero risk of LNM cannot be generalized. Patients with sessile or NP T1 CRC should be considered for surgery. Endoscopic resection of early CRC with favorable prognostic factors should be performed after careful consideration and close clinical and radiological follow-up." @default.
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• W1966692007 date "2011-04-01" @default.
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• W1966692007 title "Su1522 Incidence of Lymph Node Metastasis From Sessile or Nonpolypoid Early Colon Cancer: Stratified Criteria to Decide When to Operate or When to Watch" @default.
• W1966692007 doi "https://doi.org/10.1016/j.gie.2011.03.576" @default.
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