T1 colorectal cancer management in the era of minimally invasive endoscopic resection

Table 1 Common endoscopic techniques, specific applications, and associated outcomes

Endoscopic technique	Application in T1 CRC	Outcomes	Advantages	Disadvantages
EMR	Recommended for lesions < 20 mm due to risk of piecemeal resection	En-bloc resection: 85.2%[44]; R0 resection: 83.9%[44]	Widely available, efficient, less resource intensive, high technical success in expert centers	Limited en-bloc resection rate with increasing size
ESD	Recommended for T1 CRC without signs of deep submucosal invasion	En-bloc resection: 98.7%[45]; R0 resection: 97.4%[45]	High en-bloc resection, technical success, and clinical success rate	Resource intensive and requires specific training
EFTR	Primary and secondary resection of T1 CRC	Technical success: 87.0%[48]; R0 resection: 85%[48]	High en-bloc and R0 resection rate, particularly for deep invasion and submucosal fibrosis	Depends on local expertise and technology availability. Risk of appendicitis and heightened risk of delayed perforation
TES: TEM, TAMIS	Rectal T1 CRC	TEM: En-bloc resection: 97.0%[57]; R0 resection: 93.0%[57]	Full thickness-resection. High en-bloc and R0 resection rate, particularly for deep invasion	For rectal lesions only. Resource intensive and requires specific training. May affect planes for completion total mesorectal excision

EFTR: Endoscopic full-thickness resection; EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection; TAMIS: Transanal minimally invasive surgery; TEM: Transanal endoscopic microsurgery; TES: Transanal endoscopic surgery; CRC: Colorectal cancer.