Aims According to the Japanese (JSCCR) and European (ESGE) guidelines, the presence of
deep submucosal infiltration (> 1000µm), poor tumor differentiation, lympho-vascular
invasion, or grade 2-3 tumor budding on a T1 colorectal carcinoma (T1CRC) endoscopically
resected should lead to additional surgery with lymph node dissection. The aim of
this study was to evaluate practices in France concerning the quality of the pathology
report (PR) and the adherence to guidelines in endoscopic treatment for T1CRC.
Methods We conducted a retrospective study including all patients with endoscopic resection
for T1CRC performed in eight French expert centers between March 2012 and July 2019.
We collected demographic, clinical, endoscopic and histological data.
Results 223 patients were included. The mean age of the population was 70.9±10.9 years. Concerning
the quality of PR, R0 or R1 vertical margin was indicated in 100% of cases; depth
of submucosal invasion was missing in 6 (2.7%) PR; tumor differentiation was missing
in 9 (4.0%) PR; tumor budding was missing in 24 (10.8%) PR; lympho-vascular invasion
was missing in 9 (4.0%) PR. Overall, at least one histological feature was missing
in 32 (14.3%) PR and at least two histological features were missing in 14 (6.3%)
PR. Concerning the adherence to guidelines, 179 (82.1%) of the decisions were consistent
with the guidelines. Regarding the 39 (17.9%) patients for whom the guidelines were
not followed, 19/39 (48.7%) were not operated because they declined or were not fit
for surgery, which brings to 20/218 (9.2%) the number of patients deviating from the
guidelines without justification.
Conclusions This multicenter study indicates that 14% of pathology reports for endoscopically
resected T1CRC are incomplete and that patient management deviates from international
guidelines without justification in 9% of patients. The creation of a dedicated multidisciplinary
meeting for superficial gastro-intestinal cancers in each therapeutic endoscopy center
could help improving these points.
