Abstract
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.
Highlights
Adoption of a nationwide screening program and recent advances in endoscopic instruments and techniques have led to the increased detection of early colon cancer (ECC) and reduction in colorectal cancer (CRC) incidence and mortality [1]
According to the guidelines issued by the Japanese Society for Cancer of the Colon and Rectum (JSCCR) in 2016 [9], non-curative endoscopic resection (ER) (NC-ER) for The diagnosis of submucosal invasive CRC (T1 CRC) is defined based on the presence of at least one of the following criteria: (i) unfavorable histologic subtypes, (ii) deep submucosal invasion (submucosal invasion depth (SID) ≥1000 μm in non-pedunculated cancers), (iii) positive lymphovascular invasion (LVI) or (iv) positive or undetermined resection margins
The present study revealed two main results for long-term outcomes of T1 CRCs after ER
Summary
Adoption of a nationwide screening program and recent advances in endoscopic instruments and techniques have led to the increased detection of early colon cancer (ECC) and reduction in colorectal cancer (CRC) incidence and mortality [1]. 5–10% of patients with T1 CRC have LNM or distant metastasis; they require additional surgical resection with lymph node dissection (ASR) after ER to ensure complete tumor clearance [7,8]. Endoscopic resection (ER) for submucosal invasive colorectal cancer (T1 CRC) can be grouped as curative ER (C-ER) and non-curative ER (NC-ER). We have evaluated the long-term outcomes in endoscopically resected T1 CRC patients in C-ER and NC-ER groups. 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). 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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