• Anders L Ebbehøj, Henry G Smith, Lars N Jørgensen, and Peter-Martin Krarup.
• Digestive Disease Center, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.
• Ann. Surg. 2023 Jan 1; 277 (1): 127135127-135.

ObjectiveTo investigate whether there is a differential impact of histopathological risk factors for lymph node metastases (LNM) in pedunculated and nonpedunculated pT1 colorectal cancers (CRC).BackgroundTumor budding, lymphovascular invasion (LVI), and venous invasion (VI) are recognized risk factors for LNM in pT1 CRC. Whether the importance of these factors varies according to tumor morphology is unknown.MethodsPatients undergoing resection with lymphadenectomy for pT1 CRC in Denmark from January 2016 to January 2019 were identified in the Danish Colorectal Cancer Database and clinicopathological data was reviewed. Prognostic factors for LNM were investigated using multivariable analyses on the cohort as a whole as well as when stratifying according to tumor morphology (pedunculated vs. nonpedunculated).ResultsA total of 1167 eligible patients were identified, of whom 170 had LNM (14.6%). Independent prognostic factors for LNM included LVI [odds ratio (OR)=4.26, P <0.001], VI (OR=3.42, P <0.001), tumor budding (OR=2.12, P =0.002), high tumor grade (OR=2.76, P =0.020), and age per additional year (OR=0.96, P <0.001). On subgroup analyses, LVI and VI remained independently prognostic for LNM regardless of tumor morphology. However, tumor budding was only prognostic for LNM in pedunculated tumors (OR=4.19, P <0.001), whereas age was only prognostic in nonpedunculated tumors (OR=0.61, P =0.003).ConclusionsWhile LVI and LI were found to be prognostic of LNM in all pT1 CRC, the prognostic value of tumor budding differs between pedunculated and nonpedunculated tumors. Thus, tumor morphology should be taken into account when considering completion surgery in patients undergoing local excision.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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