Due to new insights regarding the relation between depth of submucosal invasion and the risk of lymph node metastases in T1 colorectal cancer (CRC), an increasing number of patients with colorectal cancer may be offered an organ-preserving treatment instead of oncologic surgery.
1 To date, an endoscopic, full-thickness resection (eFTR) is the only transmural endoscopic modality to use when a colonic lesion is suspicious for deep submucosal invasion (DSI); however, R0-resection rates are negatively associated with increasing size of the lesion.
2 When the lesion is smaller than 15 mm, the R0-resection rate of eFTR is 90%, but when there is a suspicion of T1 CRC and the lesion is 16–20 mm or >20 mm, R0 resection-rates decrease to 71% and 11%, respectively.
2 As a consequence, lesions greater than 15 mm that are suspicious for DSI are currently often referred for a major oncologic resection, which is known to be associated with significant morbidity (25%) and mortality (2%).
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