BACKGROUND AND AIMS Current international guidelines recommend endoscopic resection for T1 colorectal cancer (CRC) with low-risk histology features and oncologic resection for those at high risk of lymphatic metastasis. Exact risk stratification is therefore crucial to avoid under-treatment as well as over-treatment. Endoscopic full-thickness resection (EFTR) has shown to be effective for treatment of non-lifting benign lesions. In this multicenter, retrospective study we aimed to evaluate efficacy, safety, and clinical value of EFTR for early CRC. METHODS Records of 1234 patients undergoing EFTR for various indications at 96 centers were screened for eligibility. A total of 156 patients with histologic evidence of adenocarcinoma were identified. This cohort included 64 cases undergoing EFTR after incomplete resection of a malignant polyp (group 1) and 92 non-lifting lesions (group 2). Endpoints of the study were: technical success, R0-resection, adverse events, and successful discrimination of high-risk versus low-risk tumors. RESULTS Technical success was achieved in 144 out of 156 (92.3%). Mean procedural time was 42 minutes. R0 resection was achieved in 112 of 156 (71.8%). Subgroup analysis showed a R0 resection rate of 87.5% in Group 1 and 60.9% in Group 2 (P < .001). Severe procedure-related adverse events were recorded in 3.9% of patients. Discrimination between high-risk versus low-risk tumor was successful in 155 of 156 cases (99.3%). In Group 1, 84.1% were identified as low-risk lesions, whereas 16.3% in group 2 had low-risk features. In total, 53 patients (34%) underwent oncologic resection due to high-risk features whereas 98 patients (62%) were followed endoscopically. CONCLUSIONS In early colorectal cancer, EFTR is technically feasible and safe. It allows exact histological risk stratification and can avoid surgery for low-risk lesions. Prospective studies are required to further define indications for EFTR in malignant colorectal lesions and to evaluate long-term outcome.

中文翻译：

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内镜全层切除术治疗早期大肠癌。

背景和目的目前的国际指南建议对具有低风险组织学特征的T1大肠癌（CRC）进行内镜切除，对那些具有高淋巴转移风险的人建议进行肿瘤学切除。因此，准确的风险分层对于避免治疗不足和过度治疗至关重要。内镜全层切除术（EFTR）已显示可有效治疗非隆起性良性病变。在这项多中心回顾性研究中，我们旨在评估EFTR对早期CRC的疗效，安全性和临床价值。方法筛选了在96个中心进行的1234例接受EFTR治疗的各种适应症患者的记录。总共鉴定出156例具有腺癌组织学证据的患者。该队列包括64例恶性息肉不完全切除后行EFTR的患者（第1组）和92例非抬高性病变（第2组）。该研究的终点是：技术成功，R0切除，不良事件以及成功区分高危和低危肿瘤。结果在156个案例中，有144个案例获得了技术成功（92.3％）。平均手术时间为42分钟。156例中的112例（71.8％）实现了R0切除。亚组分析显示，第1组的R0切除率为87.5％，第2组的R0切除率为60.9％（P <.001）。3.9％的患者记录了与手术相关的严重不良事件。在156例病例中，有155例成功区分了高危和低危肿瘤（99.3％）。在第1组中，有84.1％被确定为低危病灶，而在第2组中有16.3％被确定为低危病灶。总共，53例（34％）由于高危特征而接受了肿瘤切除术，而内镜下随访了98例（62％）。结论在早期结直肠癌中，EFTR在技术上是可行且安全的。它可以进行精确的组织学风险分层，并可以避免因低风险病灶而进行手术。需要进行前瞻性研究以进一步确定恶性大肠病变中EFTR的适应症并评估长期预后。