Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway.
Gut Liver. 2021 Nov 15;15(6):818-826. doi: 10.5009/gnl20224.
With the widely spreading population-based screening programs for colorectal cancer and recent improvements in endoscopic diagnosis, the number of endoscopic resections in subjects with T1 colorectal cancer has been increasing. Some reports suggest that endoscopic resection prior to surgical resection of T1 colorectal cancer has no adverse effect on prognosis and contributes to this tendency. The decision on the need for surgical resection as an additional treatment after endoscopic resection of T1 colorectal cancer should be made according to the metastasis risk to lymph nodes based on histopathological findings. Because lymph node metastasis occurs in approximately 10% of patients with T1 colorectal cancer according to current international guidelines, the remaining 90% of patients may be at an increased risk of surgical resection and associated postoperative mortality, with no clinical benefit derived from unnecessary surgical resection. Although a more accurate prediction system for lymph node metastasis is needed to solve this problem, risk stratification for lymph node metastasis remains controversial. In this review, we focus on the current status of risk stratification of T1 colorectal cancer metastasis to lymph nodes and outline future perspectives.
随着基于人群的结直肠癌筛查计划的广泛开展和内镜诊断的近期改进，接受 T1 结直肠癌内镜切除术的患者数量不断增加。一些报告表明，在 T1 结直肠癌的手术切除之前进行内镜切除术对预后没有不良影响，并促成了这种趋势。在决定是否需要在 T1 结直肠癌的内镜切除后进行额外的手术切除时，应根据组织病理学检查结果的淋巴结转移风险来决定。由于根据当前国际指南，T1 结直肠癌患者中约有 10%发生淋巴结转移，因此剩余的 90%患者可能会增加手术切除和相关术后死亡率的风险，而从不必要的手术切除中没有获得临床获益。尽管需要更准确的预测系统来解决这个问题，但淋巴结转移的风险分层仍然存在争议。在这篇综述中，我们重点介绍 T1 结直肠癌淋巴结转移风险分层的现状，并概述未来的展望。
