Refining the Risk of Lymph Node Metastasis in T1 Colorectal Adenocarcinoma

The optimal management for T1 colorectal adenocarcinoma remains controversial and is a frequent topic of discussion at multidisciplinary case conferences or tumor boards. This has become increasingly relevant with more widespread use of endoscopic resection and transanal local excision techniques.1 For decades, the histologic findings of lymphatic invasion, poor differentiation, and positive margins have been accepted as features that merit consideration of surgical resection and, more recently, tumor budding and deep submucosal invasion (DSI) have found their way into the pantheon of high-risk features.