T1 colorectal cancer management in the era of minimally invasive endoscopic resection

Abstract

T1 colorectal cancer (CRC), defined by tumor invasion confined to the submucosa, has historically been managed by surgery. Improved understanding of recurrence and lymph node metastases risk, coupled with advances in endoscopic resection techniques, have led to an increasing capacity for organ-sparing local excision. Minimally invasive management of T1 CRC begins with optical evaluation of the lesion to diagnose invasive disease and quantify depth of invasion, which informs therapeutic decision making. Modality selection between various available endoscopic resection techniques depends upon lesion characteristics, technique risk-benefit profiles, and location-specific implications. Following endoscopic resection, established histopathology features determine the risk of recurrence and subsequent management including surveillance or adjuvant surgical excision. The management of non-operative candidates deviates from conventional recommendations with emerging treatment strategies in select populations.

Keywords: Cancer; Colonoscopy; Endoscopy; Polyp; Surgery

Core Tip: Advances in minimally invasive endoscopic resection techniques, including endoscopic mucosal resection, endoscopic submucosal dissection, endoscopic full-thickness resection and transanal endoscopic surgery, have revolutionized the management of T1 colorectal cancer (CRC); allowing for organ preservation while mitigating the associated morbidity of colorectal surgery. Herein we outline the pre-resection, resection and post-resection phases of care for T1 CRC including emerging techniques and adjuvant strategies for non-operative candidates.