Abstract: With the evolution of endoscopic technology, the early screening for colorectal cancer has been widely promoted, and increasing numbers of patients with T1 stage colorectal cancer have undergone tumor endoscopic resection. Whether additional segmental resection and regional lymph node dissection are required after the endoscopic resection of T1 stage colorectal cancer should be based on histopathological results to determine the risk of lymph node metastasis. Some studies have shown that after additional surgery based on the risk factors in the current national and international guidelines, lymph node metastasis affects only approximately 10% of patients with T1 colorectal cancer, resulting in a large number of additional surgical excisions lacking clinical benefit. Therefore, a more accurate risk assessment system for lymph node metastasis is needed to solve this problem. This article reviews the current status of the risk factor assessment system for lymph node metastasis in T1 stage colorectal cancer and provides an overview of its future prospects.