Management of T1 colon carcinoma: less is more

Clinicians face dilemmas and challenges in the management of T1 colorectal cancer (CRC), especially for those T1 neoplasms with indeterminate differentiation of submucosal invasion. With the implementation of CRC screening programs across the globe, an increasing number of patients are being diagnosed with early-stage CRC [1]. The strategy selected to achieve curative treatment of T1 colorectal neoplasm depends on the potential for nodal metastasis. The well-defined predictive factors for nodal metastasis include 1) submucosal invasion depth, 2) lymphatic or vascular invasion, 3) poor differentiation, and 4) tumor budding [2]. While numerous studies have reported the correlation of these factors with risk for nodal metastasis, the majority rely on the subsequent pathological analysis.