AI Article Synopsis

  • Endoscopic resection (ER) is commonly used for early colorectal cancer, but the need for further surgery in cases of pathological T1 colorectal cancer (pT1CRC) is debated due to uncertain risks of lymph node metastasis (LNM).
  • This study analyzed 600 pT1CRC patients to explore the clinicopathological characteristics and LNM risk for those with lymphoid follicular replacement (LFR).
  • Findings revealed that 6.7% of patients had pT1CRC with LFR, and notably, none experienced LNM during a median follow-up of 61 months, suggesting that patients with LFR might not require additional surgical intervention even with deeper submucosal invasion.

Article Abstract

Background And Aim: Endoscopic resection (ER) is widely performed to treat early colorectal cancer. However, additional surgery for pathological T1 colorectal cancer (pT1CRC) after ER is controversial because of the imprecise prediction of lymph node metastasis (LNM). Recently, several patients of pT1CRC with lymphoid follicular replacement (LFR) without LNM have been reported. This study aimed to investigate the clinicopathological features and risk of LNM in patients with pT1CRC with LFR.

Methods: We retrospectively analyzed patients who underwent ER or surgical resection and were diagnosed with pT1CRC between January 2010 and December 2020. We defined pT1CRC with LFR as the replacement of a part of the lymphoid follicular component within the submucosal area by adenocarcinoma, with no invasion into other submucosal areas.

Results: Among the 600 eligible patients, the incidence rate of pT1CRC with LFR was 6.7% (40/600). Patients with pT1CRC with LFR represented 14.3% (37/258) of the endoscopically treated patients and 0.9% (3/342) of the surgically treated patients. For patients with pT1CRC with LFR, 80.0% (32/40) had flat and depressed lesions, and 35.0% (14/40) had submucosal invasion depth ≥1000 μm. Patients with pT1CRC with LFR had negative lymphovascular invasion, differentiated type, and budding grade 1. In the median follow-up of 61 months, patients with pT1CRC with LFR had no LNM.

Conclusions: The presence of LFR in pT1CRC may be associated with a low risk of LNM. In patients with pT1CRC with LFR, follow-up without additional surgery is possible even if the submucosal invasion depth is ≥1000 μm.

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Source
http://dx.doi.org/10.1111/jgh.16745DOI Listing

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