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Local excision of T1 colorectal cancer: good differentiation, absence of lymphovascular invasion, and limited tumor radial infiltration (≤4.25 mm) may allow avoiding radical surgery

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Abstract

Background

Early colorectal cancer (ECC) is defined as T1NXM0 colorectal cancer (CRC). Although a non-negligible number of T1-CRCs presents metastatic lymph-nodes, local excision is increasingly proposed as alternative to radical resection. Several criteria have been suggested to identify low-risk T1-CRC, but recommendations on this topic are still heterogeneous. This study aims to identify criteria associated with N+ T1-CRC, to select patients to undergo (or not) local excision.

Methods

A retrospective analysis of demographic, clinical, and histology criteria of 122 consecutive T1-CRC patients undergoing radical resection at Parma University Hospital between 2000 and 2018 has been performed.

Results

Lymph-node metastasis (LNM) was observed in 15/122 patients (12.3%). No LNM was observed among well-differentiated (G1) tumors (0/37), while 10/65 (15.4%) G2 cases as well as 5/20 (25%) G3 patients presented LNM. G1 was associated with absence of LNM (p = 0.013). After excluding G1 patients, the rate of N + T1-CRC was 17.6% (15/85). LNM was observed in 4/8 (50%) patients with lymphovascular invasion (LVI) and in 11/77 (14.2%) without LVI. LVI resulted being associated with LNM (p < 0.042). LNM was reported in 28.3% of cases with a tumor infiltration >4.25 mm (13/46), compared to 5.1% in cases with an infiltration ≤4.25 mm (2/39) (p = 0.012). In Cox regression analysis, the higher hazard ratio (HR) was reported for the LVI + and infiltration >4.25 mm (HR 24.849).

Conclusions

In patients with ECC (pT1NXM0), good differentiation (G1), absence of lymphovascular invasion (LVI-), and tumor radial infiltration ≤4.25 mm may allow performing local resection and avoiding radical surgery.

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Authors and Affiliations

  1. Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia

    Andrea Morini, Alfredo Annicchiarico, Federica De Giorgi, Elena Ferioli, Andrea Romboli, Pellegrino Crafa & Renato Costi

  2. Unità di Chirurgia Oncologica, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Arcispedale Santa Maria Nuova di Reggio Emilia, Reggio Emilia, Italia

    Andrea Morini

  3. Unità Operativa di Chirurgia Generale, Sede Ulteriore dell’Università di Parma, Ospedale di Vaio, Azienda Sanitaria Locale di Parma, Fidenza (Parma), Italia

    Alfredo Annicchiarico, Filippo Montali & Renato Costi

  4. Unità Operativa di Anatomia Patologica, Azienda Ospedaliero-Universitaria di Parma, Parma, Italia

    Federica De Giorgi, Elena Ferioli & Pellegrino Crafa

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Contributions

Substantial contributions to the conception or design of the work, the acquisition, analysis, and interpretation of data for the work, drafting the work and revising it critically for important intellectual content, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: Andrea Morini, Alfredo Annicchiarico, Renato Costi. Substantial contributions to analysis, critically revision for important intellectual content, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: Andrea Morini, Alfredo Annicchiarico, Federica De Giorgi, Elena Ferioli, Filippo Montali, Pellegrino Crafa, Renato Costi. Final approval of the version to be published: Andrea Morini, Alfredo Annicchiarico, Federica De Giorgi, Elena Ferioli, Andrea Romboli, Filippo Montali, Pellegrino Crafa, Renato Costi.

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Correspondence to Alfredo Annicchiarico.

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What does this paper add to the literature?

From the analysis of this cohort of patients with T1NXM0 colorectal cancer, a simple algorithm, based on LVI, tumor grading and depth of infiltration (≤ / > 4.5 mm), allowed identifying patients with high lymph-nodal metastasis risk to be referred to colorectal resection, and others who may skip surgery.

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Morini, A., Annicchiarico, A., De Giorgi, F. et al. Local excision of T1 colorectal cancer: good differentiation, absence of lymphovascular invasion, and limited tumor radial infiltration (≤4.25 mm) may allow avoiding radical surgery. Int J Colorectal Dis 37, 2525–2533 (2022). https://doi.org/10.1007/s00384-022-04279-4

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