Introduction The management of T1 colorectal cancer remains controversial and not standardised. Surgical resection can offer cure in the majority of patients and provides appropriate lymph node staging and guides adjuvant treatment. Endoluminal excision has significantly reduced morbidity but risks undertreating undetected lymph node metastases. The aim of this study was to review practice in a single tertiary referral centre over a period of five years.
Method A retrospective analysis of histology reports, radiology imaging, and electronic records of all confirmed T1 cancers identified on our pathology database was undertaken. Cases between December 2006 and December 2011 were included giving a minimum follow up of 3 years.
Results There were a total of 71 (47 colon and 24 rectal) T1 cancers that were offered surgical resection. The median age at operation was 66 years (range 36–92). 10 patients (14%) were over the age of 80. Nodal metastases were present in 14 patients (20%). This was higher in rectal cancers than in colon cancers. (33% vs. 13%, p = 0.046). There was one sigmoid cancer staged as T1N2 following sigmoid resection. SM3 invasion and vascular invasion are significantly more likely to be associated with lymph node metastases. (p = 0.048 ad 0.002 respectively). No patients had local recurrences at 3 years. Three patients (4%) had distant metastases at 3 years. One patient had a node negative sigmoid cancer and the other two had rectal cancers one of which was node positive. The cancer specific mortality was 1.4% in this cohort.
Conclusion In this series lymph node metastases are less common in T1 colonic tumours than in rectal cancers. However, 16 of 24 patients (67%) who underwent a rectal resection for T1 cancers had no evidence of lymph node involvement or vascular invasion.
Disclosure of interest None Declared.