Surgery Not Needed After Complete Endoscopic Resection of Intramucosal Colorectal Cancer

Surgery Not Needed After Complete Endoscopic Resection of Intramucosal Colorectal Cancer

Douglas K. Rex, MD, MASGE, reviewing Bordet M, et al. Gastrointest Endosc 2020 Jun 23.

Intramucosal cancer (IMC) refers to dysplasia in the lamina propria of the mucosa with or without invasion of the muscularis mucosa. Such lesions are usually considered benign, and there is no clinical evidence that lymph node metastasis is a risk after complete endoscopic resection. Many experts now recommend that these lesions be called “high-grade dysplasia” to avoid confusion with lesions that meet the clinical definition of colorectal cancer, namely those with submucosal invasion. 

This was confirmed in a French study of 282 patients with IMC, in which 80.5% of patients underwent primary endoscopic resection and 19.5% underwent primary surgical resection. The lamina propria was invaded in all cases, and the muscularis mucosa was invaded in 2 cases. Follow-up data were available for 95% of patients, with a median follow-up of 6.1 years. There were no cancer recurrences and no cancer-related deaths in the group with IMC. None of the patients undergoing primary endoscopic resection were sent to surgery because of the pathologic interpretation of IMC.

Douglas K. Rex, MD, FASGE


These data provide strong support for continuing the concept that the clinical definition of colorectal cancer should be reserved for lesions with submucosal invasion. In this study, none of the patients who had endoscopic resection of a lesion called “IMC” were subsequently sent to surgery. Nevertheless, this occurs anecdotally in the U.S., suggesting that the term “IMC” can be misinterpreted.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Bordet M, Bretagne JF, Piette C, et al. Reappraisal of the characteristics, management, and prognosis of intramucosal colorectal cancers and their comparison with T1 carcinomas. Gastrointest Endosc 2020 Jun 23. (Epub ahead of print) (

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