Endoscopic submucosal dissection offers effective long-term outcomes for T1 colorectal cancer, but high-risk patients may benefit from additional surgery.

• In a study of 383 T1 CRC patients, the 5-year local recurrence rate was 6.8% in high-risk follow-up patients vs. 0% in those who had surgery (p<0.001).
• Overall survival at 5 years was significantly lower for high-risk follow-up patients at 79.7% compared to 95.2% for surgery patients (p<0.001).

Surgeons should consider additional surgery for high-risk T1 CRC to reduce recurrence, while low-risk patients can be safely monitored post-ESD.