Variability in management of T1 colorectal cancer in wales

Abstract

The management of T1 colorectal cancer is controversial. Surgical resection should offer cure in the majority of patients and can stage lymph nodes accurately. Nevertheless, there can be significant associated morbidity and it potentially risks overtreating the patient. Endoscopic/local excision has significantly reduced morbidity but risks undertreating undetected metastatic lymph nodes, thereby compromising oncological outcomes. The aim of this study was to review the practice across Wales over a two-year period. Data on T1 tumours for the period of 2009-2011 were collected from the Cancer Network Information System Cymru. A total of 161 patients were diagnosed as having T1 colorectal cancer (without prior neoadjuvant treatment). The median age was 68 years (range: 14-91 years) and 66% of the patients were male. Forty-eight (30%) of these tumours were screen detected. There were 112 colonic and 49 rectal tumours. Ninety-five patients with colonic tumours (85%) underwent major surgical resections, 51% of which were laparoscopic. Forty patients with rectal cancers (82%) underwent major surgical resection and 45% of these procedures were laparoscopic. The rest of the patients underwent local excision in the form of endoscopic polypectomy or transanal resection. This study demonstrates that there is no consensus in the management of T1 disease across Wales. With the advent of screening and the development of more sophisticated endoscopic techniques, the decision of how to treat T1 colorectal cancer will become a more regular challenge for the colorectal multidisciplinary team. The treatment needs standardisation. For now, however, this balance of risk will need to be made on an individual patient basis.