NON-INVASIVE COLORECTAL NEOPLASMS REFERRED TO SURGERY: A PERFORMANCE KEY MEASURE FOR SCREENING PROGRAMS

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Aims A large proportion of neoplasms undergo curative endoscopic resection if second-look is performed before surgery. Operator competency and limited access to advanced resection techniques may have an unfavorable impact on colorectal cancer screening. Methods Observational, multicenter study including all screening centers in a central Italy, and all patients referred to surgery due a colorectal cancer. Data were retrieved both from county registry and endoscopic charts. Primary outcome: noninvasive cancer rate (tumor not invading the submucosa on endoscopic or surgical specimens). Neoplasms were stratified at endoscopy by Paris and Borrmann classifications in superficial and deep. Secondary outcome: indefinite cancer histologic diagnosis on ER specimens (no data on submucosal invasion; indefinite T1 microstaging). Results 468 neoplasms from 13 centers defined as superficial in 188 cases and deep in 280. Superficial neoplasms underwent ER (Sup-ER) in 92 (49%), and biopsies in 96 (Sup-B) (51%). Sup-ER were smaller (P < 0.0001), more pedunculated (P < 0.0001), and in the left colon (P < 0.0001) than Sup-B. ER was complete in 76 (83%): en bloc in 45 (59%), piecemeal in 31 (41%). Noninvasive cancer rate of Sup-B (40%) was higher than Sup-ER (20%, P < 0.01); that of ulcer-negative Deep-B (20%) was higher than ulcer-positive (5%) and stricturing Deep-B (3%; P = 0.0002). Indefinite cancer histologic diagnosis rate was higher in Sup-ER underwent incomplete resection (50% vs.20%; P = 0.012). Center performance was different: noninvasive cancer rates ranged from 0% to 30% (P = 0.0581), and Sup-B from 0% to 100% (P = 0.019). Noninvasive cancer rate was < 10% in 5 centers and > 20% in 5. Conclusions Noninvasive cancer rate among cases referred to surgery was 15%, but significantly heterogeneous among centers in superficial neoplasms not underwent ER, and deep neoplasms without invasive features (i.e. stricture or ulceration). Endoscopic characterization needs to be diffusely improved, and referral centers should interrogated before surgery and provide ESD when indicated.

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