Endoscopic resection of pT1 tumors is effective if certain histological criteria for a good prognosis are met, including a resection margin > 1 mm. The FTRD (Full Thickness Resection Device) system allows resection of the entire wall thickness, making it possible to assess the presence of residual tumor.

The aim is to evaluate the role of FTRD and its safety as a complementary treatment in pT1 with borderline histological margins.

Observational, descriptive, retrospective study of patients with endoscopic scar resection using FTRD between March 2023 and June 2025.

A total of 8 FTRD resections were performed on scars from previously resected lesions with pT1 adenocarcinoma histology with a resection margin <1 mm and no evidence of macroscopic residual lesion. The mean age was 67 years, with 88% being male. In all cases except one, polypectomy (mean size 17 mm) was performed on a fragment. The histology was adenocarcinoma, and the risk factors for lymphatic metastasis (not assessable in fragmented resection) were: well or moderately differentiated, no vasculolymphatic involvement, and low tumor budding. For pedunculated polyps, the Haggitt score was ≤3, and for sessile polyps, the Kikuchi score was ≤SM2. In the anatomy after FTRD, no foci of adenocarcinoma were observed except in the scar of the fragmented polyp. There were no complications or recurrences during follow-up.

Scar resection using FTRD is an effective and safe technique that allows the treatment of pT1 tumors with positive resection margins and without high histological risk, avoiding the comorbidity and costs associated with oncological surgery. Our study shows that in the resection of the polyp in a single fragment, residual disease is 0% despite a borderline resection margin.