Surgery vs. Endoscopic Resection for Incompletely Removed Early Colon Cancer — a randomized trial asking a critical question: after incomplete removal of early colon cancer, is surgery always necessary?
SCAR focuses on a common and difficult situation in colorectal cancer care. A patient undergoes a routine colonoscopy, has what appears to be a polyp removed, and only later learns from the pathology report that it was early cancer — incompletely removed.
Current guidelines recommend surgery. Yet in most cases, no residual tumour is found in the surgical specimen. SCAR evaluates whether a second, targeted endoscopic procedure could safely replace it.
This is not a rare or theoretical scenario. Many early colon cancers are initially removed during routine colonoscopy because they appear to be benign polyps. The real diagnosis becomes clear only after histopathological assessment.
From that point, the standard pathway is usually straightforward: surgery is recommended. Yet for many patients, that means bowel resection, hospitalization, and recovery for disease that may no longer be present.
Incomplete resection of early colon cancer after routine polypectomy is a well-recognized clinical situation created by the increasing detection of early lesions through colonoscopy and screening.
Surgery is currently recommended, but in most patients no residual tumour is found. SCAR asks whether some patients are being exposed to surgical burden unnecessarily.
Current practice is guided by caution, not by randomized comparison. SCAR is the first trial designed to provide high-level evidence in this exact clinical setting.
If endoscopic completion treatment proves safe, the study could support a more precise, less invasive pathway for selected patients with early colon cancer.
Primary hypothesis: eFTR is non-inferior to surgery for cancer recurrence at 1 year and superior in reducing severe adverse events within 30 days.
SCAR evaluates more than oncological safety alone. Within ECOPOP, the trial also contributes to the assessment of treatment burden, cost-effectiveness, and environmental impact. This allows comparison of the two strategies not only in terms of cancer outcomes, but also in terms of what they demand from patients and healthcare systems.
Randomized, controlled, multicentre, international trial.
304 patients (152 per arm) across sites in Norway, Poland, Germany, Italy, France, Spain, Belgium, and Sweden.
Cancer recurrence at 1 year and severe adverse events within 30 days.
5 years, with additional analyses including long-term outcomes, cost-effectiveness, and ecological footprint.
Participation is voluntary and assessed by the clinical team at a participating site. SCAR is intended for a specific group of patients whose cancer was unexpectedly identified after routine colonoscopic removal.
Final eligibility is always determined individually by the study team according to the full protocol and clinical assessment.
Clinical centres interested in joining SCAR as study sites, or physicians wishing to refer eligible patients, are welcome to contact the coordination team.
Clinical centres interested in joining SCAR as study sites, or physicians wishing to refer eligible patients, are welcome to contact the coordination team.
Contact the teamQuestions about participation or site referral?
Email:
ecopop@gumed.edu.pl
Location:
Medical University of Gdańsk