Takamaru Hiroyuki, Tsay Cynthia, Saito Yutaka
Division of Endoscopy, National Cancer Center Hospital, Tokyo, Japan.
Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, USA.
Gut Liver. 2025 Jul 15;19(4):508-518. doi: 10.5009/gnl240460. Epub 2025 Jun 20.
Endoscopic submucosal dissection (ESD) enables en-bloc resection of large lesions more than 20 mm in size. Therefore, the use of ESD has gained broader acceptance for clinical applications globally. Previous reports on long-term outcomes after ESD, when followed by additional surgery, have also reported favorable results, positioning ESD as a crucial tool in providing minimally invasive treatment for T1 colorectal cancer (CRC). However, a lack of clear evidence regarding optimal surveillance strategies for T1 CRC following endoscopic treatments such as ESD remains. In some cases of T1 CRC, the need for additional surgery to address the risk of lymph node metastasis (LNM) remains a significant concern in daily practice. This narrative review aimed to examine the evidence on surveillance and additional surgery following the endoscopic treatment of T1 CRC by evaluating the criteria for intervention and associated risk factors. In cases where there are no unfavorable pathological features or risk factors for LNM, the risk of LNM is extremely low, and endoscopic techniques alone are typically sufficient in achieving curative resection for these patients. However, when risk factors for LNM are present, additional surgery should be considered. Several current guidelines recommend determining whether to pursue additional surgery or surveillance based on these risk factors, which must be carefully assessed according to individual patient conditions. Further studies are required to clarify the long-term prognosis, risk of lymph node or distant metastasis, and appropriate surveillance strategies, which may include salvage treatment such as additional surgery.
内镜黏膜下剥离术（ESD）能够完整切除直径超过20毫米的大病灶。因此，ESD在全球临床应用中得到了更广泛的认可。既往关于ESD术后长期结局（随后进行额外手术）的报告也显示了良好的结果，这使得ESD成为为T1期结直肠癌（CRC）提供微创治疗的关键工具。然而，对于ESD等内镜治疗后的T1期CRC，缺乏关于最佳监测策略的明确证据。在某些T1期CRC病例中，在日常实践中，为解决淋巴结转移（LNM）风险而进行额外手术的必要性仍然是一个重大问题。本叙述性综述旨在通过评估干预标准和相关危险因素，研究T1期CRC内镜治疗后监测和额外手术的证据。在不存在不利病理特征或LNM危险因素的情况下，LNM风险极低，对于这些患者，仅内镜技术通常足以实现根治性切除。然而，当存在LNM危险因素时，应考虑额外手术。目前的几项指南建议根据这些危险因素来决定是否进行额外手术或监测，必须根据个体患者情况仔细评估这些因素。需要进一步研究以阐明长期预后、淋巴结或远处转移风险以及适当的监测策略，其中可能包括额外手术等挽救性治疗。
