The T1 CRC Dilemma: Endoscopy vs Surgery
The decision that justifies the entire morning: when endoscopic resection is enough, and when the operating theatre is the right kind of expensive.
Running order (indicative)
- Head
- Dr John Andersonanchors the studio throughout
- Talk 1
- Prof David TateOptical Prediction Before, Vertical Margin After
- Talk 2
- Dr Andrea SorgeCompletion Surgery or Watch-and-Wait: Who Genuinely Needs More?
- Live case
- Prof David TateProf Alanna EbigboResected T1 CRC / suspicious lesion — optical prediction of deep invasion & MDT
- Discussion
- Allremaining session time
The session, as written
Lecture 1 — Optical prediction before, vertical margin after. (Tate). The two assessments so often confused: reading deep invasion at the scope — surface, deep margin, how deep you can and should go, the edge of what is endoscopically possible — then letting histology, not fear, drive the next decision.
Lecture 2 — Completion surgery or watch-and-wait: who genuinely needs more? Lymphovascular invasion, tumour budding, deep invasion, the positive or non-assessable margin — read against the patient's comorbidity. Surgery is high value exactly when nodal risk is clinically meaningful; reflex completion surgery for low-risk disease is harm plus cost, and the majority can be watched instead of operated.
Live case — the MDT, in public. Resected T1 cancers with real histology, put to a live multidisciplinary vote — surveillance, surgery, or risk-stratified follow-up — against what the MDT actually decided.
