Risk of recurrence after local resection of T1 rectal cancer: a meta-analysis with meta-regression

Abstract

Background T1 rectal cancer (RC) patients are increasingly being treated by local resection alone but uniform surveillance strategies thereafter are lacking. To determine whether different local resection techniques influence the risk of recurrence and cancer-related mortality, a meta-analysis was performed. Methods A systematic search was conducted for T1RC patients treated with local surgical resection. The primary outcome was the risk of RC recurrence and RC-related mortality. Pooled estimates were calculated using mixed-effect logistic regression. We also systematically searched and evaluated endoscopically treated T1RC patients in a similar manner. Results In 2585 unique T1RC patients (86 studies) undergoing local surgical resection, the overall pooled cumulative incidence of recurrence was 9.1% (302 events, 95% CI 7.3–11.4%; I2 = 68.3%). In meta-regression, the recurrence risk was associated with histological risk status (p < 0.005; low-risk 6.6%, 95% CI 4.4–9.7% vs. high-risk 28.2%, 95% CI 19–39.7%) and local surgical resection technique (p < 0.005; TEM/TAMIS 7.7%, 95% CI 5.3–11.0% vs. other local surgical excisions 10.8%, 95% CI 6.7–16.8%). In 641 unique T1RC patients treated with flexible endoscopic excision (16 studies), the risk of recurrence (7.7%, 95% CI 5.2–11.2%), cancer-related mortality (2.3%, 95% CI 1.1–4.9), and cancer-related mortality among patients with recurrence (30.0%, 95% CI 14.7–49.4%) were comparable to outcomes after TEM/TAMIS (risk of recurrence 7.7%, 95% CI 5.3–11.0%, cancer-related mortality 2.8%, 95% CI 1.2–6.2% and among patients with recurrence 35.6%, 95% CI 21.9–51.2%). Conclusions Patients with T1 rectal cancer may have a significantly lower recurrence risk after TEM/TAMIS compared to other local surgical resection techniques. After TEM/TAMIS and endoscopic resection the recurrence risk, cancer-related mortality and cancer-related mortality among patients with recurrence were comparable. Recurrence was mainly dependent on histological risk status. Graphical abstract

Treatment Options for Distal Rectal Cancer in the Era of Organ Preservation

“…TAMIS has comparable short-term and long-term efficacy as TEM in early rectal cancer, with cumulative DFS recorded in 96%, 93%, 84%, and 78% at 1, 2, 3, and 5 years. Postoperative morbidity was noted in 9–11% of patients [ 12 – 14 ]. And because the equipment installation time is omitted, TAMIS is associated with shorter operative time and length of stay [ 12 , 15 ].…”

Transanale Tumorresektion: Indikation, Operationstechniken und Komplikationsmanagement

“…Mehrere Studien konnten aufzeigen, dass durch den Einsatz von TEM oder TEO im Vergleich zur konventionellen lokalen Resektion mit dem Spreizer signifikant bessere R0-Raten erzielt werden und damit die Rezidivwahrscheinlichkeit gesenkt wird, abgesehen von der Tatsache, dass Tumoren im oberen Rektumdrittel mit der Spreizermethode gar nicht erreichbar wären [3,4,5]. Diese Daten wurden in einer aktuellen Metaanalyse nochmals zusammengefasst und grundlegend bestätigt [6].…”

Predicting rectal cancer tumor budding grading based on MRI and CT with multimodal deep transfer learning: A dual-center study

“…With the advancement of endoscopic technology, early-stage RC has become a suitable candidate for endoscopic treatment. However, whether additional radical surgery is necessary after endoscopic treatment for these patients remains a clinical challenge [ 2 ]. Currently, the presence of tumor budding (TB) has become one of the evaluation criteria for additional radical surgery after endoscopic treatment in early-stage RC patients [ 3 ].…”