Ann Surg Treat Res.  2020 Apr;98(4):199-205. 10.4174/astr.2020.98.4.199.

Characteristics of minute T1 colorectal cancer in relevance to pathology and treatment

• Park SH
• Oh SO
• Park SS
• Roh SJ
• Han KS
• Kim B
• Hong CW
• Kim BC
• Sohn DK
• Chang HJ
• Park SC
• Oh JH

• KMID: 2500820
• DOI: http://doi.org/10.4174/astr.2020.98.4.199

Abstract

Purpose
Minute T1 colorectal cancer (CRC) lesions (≤5 mm) are rare; however, little is known about their characteristics and aggressiveness. In this study, we evaluated the characteristics of minute T1 CRC in relevance to pathology and treatment.
Methods
This retrospective study included 849 patients with T1 CRC endoscopically or surgically treated between January 2001 and December 2016. The patients were stratified into 4 groups according to tumor size; minute group (≤5 mm), small group (6–10 mm), medium group (11–20 mm), and large group (≥21 mm). Clinicopathological variables were evaluated with respect to tumor size.
Results
The incidence of the minute T1 CRC was 2.4% (20 of 849). Minute T1 CRC was significantly associated with flat type (minute, 25%; small, 12.6%; medium, 8.8%; large, 12.6%; P = 0.016), right-sided cancer (30%, 15.4%, 15.4%, 15.1%, P = 0.002) and the absence of background adenoma (BGA) (50%, 40.7%, 32.8%, 18.1%, P < 0.001). In patients who underwent surgery, lymph node metastasis (LNM) was significantly higher in the minute group (36.4%, 15.9%, 15.7%, 9.2%, P = 0.029).
Conclusion
Minute T1 CRC is significantly associated with flat type, right-sided cancers, as well as with the absence of BGA and LNM. These results suggested the minute T1 CRC lesions are often aggressive and are likely to be missed during colonoscopy.

Keyword

Colonoscopy; Colorectal neoplasm; Size

Figure

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  Fig. 1 Schematic representation of the patient grouping according to tumor size. CRC, colorectal cancer.

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  Fig. 2 Representative images of endoscopic findings in patients with minute T1 colorectal cancer. Sessile type (A), flat type (B), and depressed type (C).

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  Fig. 3 Recurrence-free survival in colorectal cancer patients according to the treatment method. ER, endoscopic resection; SR, surgical resection.

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