Additional Surgical Resection After Endoscopic Resection for Patients With High-risk T1 Colorectal Cancer

Iguchi, Kenta; Mushiake, Hajime; Aoyama, Toru; Suwa, Hirokazu; Yukawa, Norio; Ota, Mitsuyoshi; Rino, Yasushi; Kunisaki, Chikara; Endo, Itaru; Masuda, Munetaka

doi:10.21873/invivo.11596

Cited by 19 publications

(17 citation statements)

References 30 publications

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“…Both cases were successfully managed with conservative treatment. After the propensity-matched analysis, anastomotic leakage was the main postoperative complication in the additional surgery group, which is concordant with the results of previ-Dig Surg 2021;38:198-204 DOI: 10.1159/000509170 ous studies [24,25]. The reason for this may be that ESD was associated with a high rate of en bloc resection, especially for the invasion of deeper submucosal lesions.…”

Section: Discussionsupporting

confidence: 79%

Does Additional Laparoscopic-Assisted Surgery after Endoscopic Submucosal Dissection Affect Short Outcomes in Patients with Stage T1 Colorectal Cancer? A Propensity Score-Based Analysis

Cheng¹,

Zhao²,

Huang³

et al. 2021

Dig Surg

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Background: Additional surgery is necessary in cases with non-curative endoscopic submucosal dissection. It is still unknown whether preceding endoscopic submucosal dissection (ESD) for T1 colorectal carcinoma affects the short outcomes of patients who underwent additional surgery or not as compared with surgery alone without ESD. Methods: Patients (101 pairs) with T1 colorectal cancer who underwent additional laparoscopic-assisted surgery after endoscopic submucosal dissection (additional surgery group, n = 101) or laparoscopic-assisted surgery alone (surgery alone group, n = 101) were matched (1:1). Short-term morbidity, operation outcomes, and lymph node metastasis of the resected specimen were compared. Results: There were no significant differences between the additional laparoscopic-assisted surgery and laparoscopic-assisted surgery alone groups in lymph node metastasis (9.9 vs. 5.9%, respectively, p = 0.297), operative time (147.76 ± 52.00 min vs. 156.50 ± 54.28 min, p = 0.205), first flatus time (3.56 ± 1.10 days vs. 3.63 ± 1.05 days, p = 0.282), first stool time (4.30 ± 1.04 days vs. 4.39 ± 1.22 days, p = 0.293), time to intake (5.00 ± 1.18 days vs. 5.25 ± 1.39 days, p = 0.079), blood loss (44.75 ± 45.40 mL vs. 60.40 ± 78.98 mL, p = 0.603), harvest lymph nodes (18.74 ± 7.22 vs. 20.32 ± 9.69, p = 0.438), postoperative surgical complications (p = 0.733), and postoperative length of hospital stay (8.68 ± 4.00 days vs. 8.39 ± 1.94 days, p = 0.401). Conclusion: ESD did not increase the difficulty of additional laparoscopic-assisted surgery, hospital stay, or the incidence of postoperative complications. Additional laparoscopic-assisted surgery is safe and recommended for patients with T1 cancer at high risk of lymph node metastasis and residual cancer after non-curative ESD.

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Section: Discussionsupporting

confidence: 79%

Does Additional Laparoscopic-Assisted Surgery after Endoscopic Submucosal Dissection Affect Short Outcomes in Patients with Stage T1 Colorectal Cancer? A Propensity Score-Based Analysis

Cheng¹,

Zhao²,

Huang³

et al. 2021

Dig Surg

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“…Showed beneficial rate of 41% for residual tumor and 8.6% for LNM. Whereas, for the aspect of risk rate, several studies have reported the postoperative complication rate of 18.8-31.8% in ASR after ER [10,11,22]. The surgical mortality rates of 1.9-6.5% for colon cancer, 3.2-9.8% upon total mesorectal resection for rectal cancer [23,24] and 0.8% upon receiving ASR after ER have been observed [25].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, in actual clinical practice, some of these patients refuse to or cannot undergo surgery for various reasons, such as old age, several significant comorbidities and individual preference. Furthermore, ASR after ER is associated with an overall mortality of 1-5% and morbidity of 30%, especially in elderly people [10,11].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Outcomes of T1 Colorectal Cancer after Endoscopic Resection

Park

Baek

Lee

et al. 2020

JCM

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Background and Aims: Endoscopic resection (ER) for submucosal invasive colorectal cancer (T1 CRC) can be grouped as curative ER (C-ER) and non-curative ER (NC-ER). Little is known about the long-term outcomes of patients in these two groups. Therefore, we have evaluated the long-term outcomes in endoscopically resected T1 CRC patients in C-ER and NC-ER groups. Methods: We conducted a retrospective study on 220 patients with T1 CRC treated with ER from January 2007 to December 2017. First, we investigated the long-term outcomes (5-year overall survival [OS] and recurrence-free survival [RFS]) in the C-ER group (n = 49). In the NC-ER group (n = 171), we compared long-term outcomes between patients who underwent additional surgical resection (ASR) (n = 117) and those who did not (surveillance-only, n = 54). Results: T1 CRC patients in the C-ER and NC-ER groups had a median follow-up of 44 (interquartile range 32–69) months. There was no risk of tumor recurrence and cancer-related deaths in patients with C-ER. In the NC-ER group, the 5-year OS rates were 75.3% and 92.6% in the surveillance-only and ASR subgroups, respectively. The hazard ratio (HR) for ASR in NC-ER vs. surveillance-only in NC-ER was statistically insignificant. However, RFS rates were significantly different between the ASR (97.2%) and surveillance-only (84.0%) subgroups. Multivariate analysis indicated a submucosal invasion depth (SID) of >2500 µm and margin positivity to be associated with recurrence. Conclusions: The surveillance-only approach can be considered as an alternative surgical option for T1 CRCs in selected patients undergoing NC-ER.

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“…Twenty-nine studies were performed in Asia (2043 patients), 32 in Europe (2902 patients), 9 in North-America (208 patients), and 1 in South America (14 patients). Only 6 studies 26,35,39,45,61,81 had maximum scores for all 6 risk of bias items. Publication bias was not evident from the funnel plot (Supplementary Figure 2).…”

Section: Study Characteristicsmentioning

confidence: 98%

Risk and Time Pattern of Recurrences After Local Endoscopic Resection of T1 Colorectal Cancer: A Meta-analysis

Dekkers

Cessie

Hooft

et al. 2022

Clinical Gastroenterology and Hepatology

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High-risk: 7.0% Low-risk: 0.7% BACKGROUND & AIMS:Growing numbers of patients with T1 CRC are being treated with local endoscopic resection only and as a result, the need for optimization of surveillance strategies for these patients also increases. We aimed to estimate the cumulative incidence and time pattern of CRC recurrences for endoscopically treated patients with T1 CRC. METHODS:Using a systematic literature search in PubMed, EMBASE, Web of Science and Cochrane Library (from inception till 15 May 2020), we identified and extracted data from studies describing the cumulative incidence of local or distant CRC recurrence for patients with T1 CRC treated with local endoscopic resection only. Pooled estimates were calculated using mixed-effect logistic regression models. RESULTS:Seventy-one studies with 5167 unique, endoscopically treated patients with T1 CRC were included. The pooled cumulative incidence of any CRC recurrence was 3.3% (209 events; 95% CI, 2.6%-4.3%; I 2 [ 54.9%), with local and distant recurrences being found at comparable rates (pooled incidences 1.9% and 1.6%, respectively). CRC-related mortality was observed in 42 out of 2519 patients (35 studies; pooled incidence 1.7%, 95% CI, 1.2%-2.2%; I 2 [ 0%), and the CRC-related mortality rate among patients with recurrence was 40.8% (42/103 patients). The vast majority of recurrences (95.6%) occurred within 72 months of follow-up. Pooled incidences of any CRC recurrence were 7.0% for high-risk T1 CRCs (28 studies; 95% CI, 4.9%-9.9%; I 2 [ 48.1%) and 0.7% (36 studies; 95% CI, 0.4%-1.2%; I 2 [ 0%) for low-risk T1 CRCs. CONCLUSIONS:Our meta-analysis provides quantitative outcome measures which are relevant to guidelines on surveillance after local endoscopic resection of T1 CRC.

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Additional Surgical Resection After Endoscopic Resection for Patients With High-risk T1 Colorectal Cancer

Cited by 19 publications

References 30 publications

Does Additional Laparoscopic-Assisted Surgery after Endoscopic Submucosal Dissection Affect Short Outcomes in Patients with Stage T1 Colorectal Cancer? A Propensity Score-Based Analysis

Does Additional Laparoscopic-Assisted Surgery after Endoscopic Submucosal Dissection Affect Short Outcomes in Patients with Stage T1 Colorectal Cancer? A Propensity Score-Based Analysis

Long-Term Outcomes of T1 Colorectal Cancer after Endoscopic Resection

Risk and Time Pattern of Recurrences After Local Endoscopic Resection of T1 Colorectal Cancer: A Meta-analysis

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