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Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction
Published on: March 24, 2023
Rethinking surgical strategy for margin-positive only T1 colorectal cancer: a multicenter retrospective cohort study
Jin Hyeong Park1, Chang Hwan Kim1, Dae Hee Pyo1
1Department of Surgery, College of Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
International Journal of Colorectal Disease
|June 20, 2026
Summary
For early T1 colorectal cancer (CRC) treated with endoscopic resection, a positive margin alone did not lead to lymph node metastasis (LNM) in selected patients. Further research is needed to confirm if radical resection can be avoided in these low-risk cases.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Pathology
Background:
- Early T1 colorectal cancer (CRC) is often treated with endoscopic resection.
- Additional surgery is recommended if histopathological risk factors are present after resection.
- Lymph node metastasis (LNM) occurs in approximately 10% of T1 CRC patients undergoing radical resection.
Purpose of the Study:
- To identify factors influencing radical resection decisions for T1 CRC post-endoscopic resection.
- To evaluate LNM rates based on specific risk factors.
- To determine if radical resection can be safely omitted in select low-risk T1 CRC cases.
Main Methods:
- Retrospective, multicenter comparative cohort study at three Korean tertiary referral centers.
- Included patients with pathological T1 CRC who underwent radical resection after endoscopic resection (April 2019 - December 2024).
- Primary outcome: LNM incidence related to pathological risk factors, especially margin-positive cases without other risks. Univariate analyses and exact binomial confidence intervals were used.
Main Results:
- 250 patients underwent radical surgery; 25 (10.0%) had LNM.
- Lymphovascular invasion and KRAS mutation were significantly linked to LNM.
- Twenty-two patients with margin positivity but no other risk factors showed 0% LNM (95% CI: 0-15.4%). Half had no residual tumor, the rest had only submucosal residual tumors.
Conclusions:
- Margin positivity alone, without other high-risk features, was not associated with LNM in this T1 CRC cohort.
- These findings are hypothesis-generating due to small sample size and wide confidence intervals.
- Further validation is required to confirm if radical resection can be avoided in carefully selected T1 CRC patients with margin positivity only.
