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. 2022 Apr 14;10(4):E282-E290.
doi: 10.1055/a-1736-6960. eCollection 2022 Apr.

Impact of ≥ 0.1-mm free resection margins on local intramural residual cancer after local excision of T1 colorectal cancer

Kim M Gijsbers  1   2 , Lisa van der Schee  1 , Tessa van Veen  1 , Annemarie M van Berkel  3 , Femke Boersma  4 , Carolien M Bronkhorst  5 , Paul D Didden  1 , Krijn J C Haasnoot  1 , Anne M Jonker  6 , Koen Kessels  7 , Nikki Knijn  8 , Ineke van Lijnschoten  9 , Clinton Mijnals  10 , Anya N Milne  11 , Freek C P Moll  12 , Ruud W M Schrauwen  13 , Ramon-Michel Schreuder  14 , Tom J Seerden  15 , Marcel B W M Spanier  16 , Jochim S Terhaar Sive Droste  17 , Emma Witteveen  18 , Wouter H de Vos Tot Nederveen Cappel  19 , Frank P Vleggaar  1 , Miangela M Laclé  20 , Frank Ter Borg  2 , Leon M G Moons  1 ; Dutch T1 CRC Working Group
Affiliations

Impact of ≥ 0.1-mm free resection margins on local intramural residual cancer after local excision of T1 colorectal cancer

Kim M Gijsbers et al. Endosc Int Open. .

Abstract

Background and study aims A free resection margin (FRM) > 1 mm after local excision of a T1 colorectal cancer (CRC) is known to be associated with a low risk of local intramural residual cancer (LIRC). The risk is unclear, however, for FRMs between 0.1 to 1 mm. This study evaluated the risk of LIRC after local excision of T1 CRC with FRMs between 0.1 and 1 mm in the absence of lymphovascular invasion (LVI), poor differentiation and high-grade tumor budding (Bd2-3). Patients and methods Data from all consecutive patients with local excision of T1 CRC between 2014 and 2017 were collected from 11 hospitals. Patients with a FRM ≥ 0.1 mm without LVI and poor differentiation were included. The main outcome was risk of LIRC (composite of residual cancer in the local excision scar in adjuvant resection specimens or local recurrence during follow-up). Tumor budding was also assessed for cases with a FRM between 0.1 and 1mm. Results A total of 171 patients with a FRM between 0.1 and 1 mm and 351 patients with a FRM > 1 mm were included. LIRC occurred in five patients (2.9 %; 95 % confidence interval [CI] 1.0-6.7 %) and two patients (0.6 %; 95 % CI 0.1-2.1 %), respectively. Assessment of tumor budding showed Bd2-3 in 80 % of cases with LIRC and in 16 % of control cases. Accordingly, in patients with a FRM between 0.1 and 1 mm without Bd2-3, LIRC was detected in one patient (0.8%; 95 % CI 0.1-4.4 %). Conclusions In this study, risks of LIRC were comparable for FRMs between 0.1 and 1 mm and > 1 mm in the absence of other histological risk factors.

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Conflict of interest statement

Competing interests Dr. Moons is consultant for Boston Scientific.

Figures

Fig. 1
Fig. 1
Study flowchart. CRC, colorectal cancer; N, number of patients; R1, positive resection margin; other pathological risk factors include lymphovascular invasion, poor differentiation, and deep invasion in pedunculated tumors.
Fig. 2
Fig. 2
Follow-up characteristics of patients with a free resection margin between 0.1 and 1 mm with LIRC or metastasis.
See this image and copyright information in PMC

References

    1. Vermeer N CA, Backes Y, Snijders H S et al.National cohort study on postoperative risks after surgery for submucosal invasive colorectal cancer. BJS Open. 2019;3:210–217. - PMC - PubMed
    1. de Neree Tot Babberich M PM, Vermeer N CA, Wouters M et al.Postoperative Outcomes of Screen-Detected vs Non-Screen-Detected Colorectal Cancer in the Netherlands. JAMA Surg. 2018;153:e183567. - PMC - PubMed
    1. Bosch S L, Teerenstra S, de Wilt J H et al.Predicting lymph node metastasis in pT1 colorectal cancer: a systematic review of risk factors providing rationale for therapy decisions. Endoscopy. 2013;45:827–834. - PubMed
    1. Di Gregorio C, Bonetti L R, de Gaetani C et al.Clinical outcome of low- and high-risk malignant colorectal polyps: results of a population-based study and meta-analysis of the available literature. Intern Emerg Med. 2014;9:151–160. - PubMed
    1. Ferlitsch M, Moss A, Hassan C et al.Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2017;49:270–297. - PubMed