Long-term Outcomes after Endoscopic Submucosal Dissection for T1 Colorectal Cancer: A Multicenter Prospective Study - PubMed

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Prospective study evaluates long-term outcomes of endoscopic submucosal dissection (ESD) for T1 colorectal cancer (CRC).
Patients classified into low- and high-risk groups based on JSCCR guidelines.
High-risk patients underwent additional surgery or were followed without surgery.
5-year cumulative recurrence rate was the primary outcome.
No recurrence or disease-specific mortality observed in low-risk group.
High-risk group had 3.6% recurrence rate and 1.8% T1 CRC-associated deaths.
Follow-up group in high-risk had higher local recurrence than surgery group (6.8% vs. 0%).
No significant difference in distant recurrence between follow-up and surgery groups.
Overall survival worse in follow-up group (79.7%) vs. surgery group (95.2%).
Disease-specific survival similar between follow-up (98.4%) and surgery groups (98.5%).
ESD alone deemed appropriate for low-risk T1 CRC without intensive surveillance.
Additional surgery for high-risk T1 CRC prevents local recurrence but unclear impact on distant metastasis and DSS.

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