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Johnstone, Mark S. and McSorley, Stephen T. and McMahon, Andrew J. (2023) Management of malignant T1 colorectal cancer polyps: results from a 10-year prospective observational study. Colorectal Disease, 25 (10). pp. 1960-1972. ISSN 1462-8910

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Surveillance may be safe for more T1 CRC polyp patients. Multidisciplinary team discussion and informed patient choice are critical.

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Abstract

Aim:
The recurrence risk associated with residual malignant cells (bowel wall/regional nodes) following T1 colorectal cancer (CRC) polypectomy must be weighed against operative morbidity. Our aim was to describe the management and outcomes of a large prospective cohort of T1 CRCs.

Method:
All T1 CRCs diagnosed between March 2007 and March 2017 at the Glasgow Royal Infirmary were included. Patients were grouped by polypectomy, rectal local excision and formal resection status. χ2 testing, multivariate binary logistic and Cox regression were performed.

Results:
Of 236 patients, 90 (38.1%) underwent polypectomy only, six (2.6%) polypectomy and then rectal excision, 57 (24.2%) polypectomy and then resection, 14 (5.9%) rectal excision only and 69 (29.2%) primary resection. Polypectomy only correlated with male sex (P = 0.028), older age (P < 0.001), distal CRCs (P < 0.001) and pedunculated polyps (P < 0.001); primary resection with larger polyps (P < 0.001); polypectomy then resection with piecemeal excision (P = 0.002) and involved polypectomy margin (P < 0.001). Poor differentiation (OR 7.860, 95% CI 1.117–55.328; P = 0.038) independently predicted lymph node involvement. Submucosal venous invasion (hazard ratio [HR] 10.154, 95% CI 2.087–49.396; P = 0.004) and mucinous subtype (HR 7.779, 95% CI 1.566–38.625; P = 0.012) independently predicted recurrence. Submucosal venous invasion (HR 5.792, 95% CI 1.056–31.754; P = 0.043) predicted CRC-specific survival. Although 64.4% of polypectomy-only patients had margin involvement/other risk factors, none developed recurrence. Of 94 with polypectomy margin involvement, five (5.3%) had confirmed residual tumour. Overall, lymph node metastases (7.1%), recurrence (4.2%) and cancer-specific mortality (3.0%) were rare. Cancer-specific 5-year survival was high: polypectomy only (100%), polypectomy and then resection (98.2%), primary resection (100%).

Conclusion:
Surveillance may be safe for more T1 CRC polyp patients. Multidisciplinary team discussion and informed patient choice are critical.

People

Johnstone, Mark S.

Author

Publications

Johnstone, Mark S. and McSorley, Steven T. and McMillan, Donald C. and Horgan, Paul G. and Mansouri, David (2024) The relationship between systemic inflammatory response, screen detection and outcome in colorectal cancer. Colorectal Disease, 26 (1). pp. 81-94. ISSN 1462-8910

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McSorley, Steven T.

Author

Publications

Dolan, Ross D. and Pennel, Kathryn and Thompson, Joshua and McKenzie, Molly and Alexander, Peter and Richards, Colin and Black, Douglas and Abbass, Tanvir and Maka, Noori and McGovern, Josh and Roseweir, Antonia and McSorley, Stephen T. and Horgan, Paul G. and Roxburgh, Campbell and McMillan, Donald C. and Edwards, Joanne (2025) The relationship between tumour necrosis, systemic inflammation, body composition and survival in patients with colon cancer. BJC Reports, 3 (1): 7. ISSN 2731-9377

Ingham, Abigail R. and McSorley, Stephen T. and McMillan, Donald C. and Chong, David and Mackay, Graham J. and Wrobel, Aleksandra and Kong, Chia Yew and Alani, Ahmed and Nicholson, Gary and Roxburgh, Campbell S.D. (2025) Does robotic assisted surgery mitigate obesity related systemic inflammatory response and clinical outcomes in left sided colorectal cancer resections? Journal of Robotic Surgery, 19 (1): 98. ISSN 1863-2483

Brown, Leo R. and Thomson, Georgina G. and Gardner, Ellen and Chien, Siobhan and McGovern, Josh and Dolan, Ross D. and McSorley, Stephen T. and Forshaw, Matthew J. and McMillan, Donald C. and Wigmore, Stephen J. and Crumley, AndrewB. and Skipworth, Richard J.E. (2024) Cachexia index for prognostication in surgical patients with locally advanced oesophageal or gastric cancer: multicentre cohort study. British Journal of Surgery, 111 (4): znae098. ISSN 0007-1323