Endoscopic treatment for high-risk T1 colorectal cancer: is it better to begin with endoscopic or surgical treatment?
We read with interest the article “Endoscopic resection of high-risk T1 colorectal carcinoma prior to surgical resection has no adverse effect on long-term outcomes” by Overwater et al., which was published in Gut (1). Endoscopic resection, including polypectomy and endoscopic mucosal resection (EMR), is a widely recognized treatment for early gastrointestinal malignancies. Endoscopic submucosal dissection (ESD) is accepted as a minimally invasive treatment for early-stage colorectal cancer (CRC), and this approach enables en bloc resection of a specimen (2). In certain cases, endoscopic treatment alone is insufficient for disease control, and additional surgical treatment after EMR is recommended for patients with high-risk T1 CRC (3,4). However, endoscopic resection of T1 CRC prior to surgical resection might worsen oncologic outcomes by accelerating the growth of the remaining tumor and promoting cancer cell dissemination and metastasis. For high-risk T1 CRC, relatively little is known about whether endoscopic resection before surgery influences lymph node metastasis (LNM), recurrence, or long-term survival.