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Session:: ePosters-Mon800-M6: Colon & Colorectal Cancer

EP767 - T1 Colon Cancer: Does What We Do Make A Difference?

Monday, May 11, 2026
8:38 AM - 8:43 AM ET

    ePoster Presenter(s)

  • Koby Herman, MD

    Fellow
    Henry Ford Providence Hospital
    Henry Ford Providence Hospital
    Ferndale, MI, United States

    Disclosure information not submitted.

    View ePoster

    • Author(s)

  • Saleh Busbait

    Colorectal Surgery Fellow
    Henry Ford Providence Hospital
    Southfield, MI, United States

    All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

  • ED

    Ernesto R. Drelichman, MD

    President Elect Medical Staff
    Henry Ford Health
    rochester hills, Michigan, United States

    Disclosure information not submitted.

  • GC

    Gautham Chitragari, MD

    Colorectal surgeon
    Cornerstone Medical Group/Henry Ford Health
    Rochester Hills, Michigan, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Jasneet S. Bhullar, MD, MS, FACS, FASCRS.

    Clinical Associate Professor of Surgery MSU/CHM, Program Director Colorectal Surgery Fellowship MSU
    Henry Ford Health
    Henry Ford- MSU Colorectal Surgery Fellowship, MI
    Rochester Hills, Michigan, United States

    All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no relevant financial relationships.

Purpose/Background: The treatment options for T1 colorectal cancer (CRC) are broad, ranging from endoscopy-based excisions to surgical resection, both limited and radical. The choice of treatment weighs both individualized patient-related factors and oncologic-risk based on histopathologic features of the tumor. Striking the correct balance between addressing the risk of lymph node metastases and limiting morbidity of therapeutic intervention remains a key focus of research in this area.

Methods/Interventions: A review of the available literature regarding the safety and outcomes of available interventions for treatment of T1 colon cancer was performed, including PUBMED, MEDLINE and Cochrane Databases. Case reports involving a single patient and studies including only rectal tumors were excluded.

Results/Outcomes: Of the 934 results, 55 articles were reviewed. Endoscopic options for resection of T1 CRC include snare polypectomy, endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD) and the use of a full-thickness resection device (FTRD). Polypectomy alone is the least successful in achieving an R0 resection (37.5%). While ESD is effective, particularly for larger lesions, it carries a risk of perforation (5-67%). FTRD is a promising tool that is safe (rate of adverse events: 0-13%) and effective for resection of T1 cancers (R0 resection: 66-100%), however there is little data on long-term oncologic outcomes.

Surgical intervention is required for positive margins following endoscopic resection and/or high risk features (positive margins, deep submucosal invasion, lymphovascular invasion, poor differentiation). An innovative bridge between endoscopy and primary surgery is colonoscopy-assisted limited surgical resections, resulting in high rates of R0 resection (R0 resection: 88.9-100%) and patient safety in available studies.

Surgery is well-tolerated and almost certainly results in an R0 resection. While the data is variable, surgical resection confers better oncologic outcomes as compared to endoscopic resection alone (5-yr OS: 58-82% vs 83.9-96.3%) , although the differences are rarely statistically significant. 5-year OS and Disease-free survival is high across all studies. Surgery following endoscopic resection or limited resection rather than a radical/oncologic resection does not significantly impact outcomes. LN+ disease results in significantly reduced oncologic survival outcomes (5-yr RFS: 66.4 vs 97.3%).

Conclusion/Discussion: The available literature overwhelmingly supports the notion that for T1 CRC the choice in intervention is less impactful on oncologic outcomes than the risk profile of the individual tumor. Tumors with high-risk features are more likely to benefit from surgical resection, but endoscopic resection is still a valid option for many patients and there are evolving strategies in that effort. The extent of resection does not appear to be significant, as long as an R0 resection is achieved. The choice of intervention should be tailored to the individual patient and guided by histopathology.

Review of Treatment and Outcomes for T1 CRC
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26. La Torre M, Nigri G, Mazzuca F, et al. Standard versus limited colon resection for high risk T1 colon cancer. A matched case-control study. J Gastrointestin Liver Dis. 2014 Sep;23(3):285-90. doi: 10.15403/jgld.2014.1121.233.mlt.

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29. Hanevelt J, Moons LMG, Hentzen JEKR, et al. Colonoscopy-Assisted Laparoscopic Wedge Resection for the Treatment of Suspected T1 Colon Cancer. Ann Surg Oncol. 2023 Apr;30(4):2058-2065. doi: 10.1245/s10434-022-12973-4.

30. Zhou QB, Yang SX, Cui WM, et al. Application of robotic (or laparoscopic) surgery combined with colonoscopy in T1 stage colorectal cancer surgery: 13 cases. Zhonghua Wei Chang Wai Ke Za Zhi. 2023 Aug 25;26(8):763-767. Chinese. doi: 10.3760/cma.j.cn441530-20230508-00154.

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