No Benefit of Surgery Over Endoscopic Resection for T1 Colorectal Cancer

colon cancer cell
colon cancer cell
A team of investigators conducted a meta-analysis and systematic review to compare outcomes of endoscopic resection vs surgery for T1 colorectal cancer.

Endoscopic resection (ER) and surgery were found to have similar rates of recurrence of and survival from T1 colorectal cancer (CRC), according to the results of a systematic review and meta-analysis published in Clinical Gastroenterology and Hepatology.

Literature databases were searched for studies of T1 CRC that compared ER with surgery and included some data on overall survival, disease-specific survival, 5-year recurrence-free survival, and/or metastasis. A total of 17 studies comprising 19,979 patients were included; these were retrospective cohort studies with a minimum mean or median follow-up of 36 months. The studies were conducted in Japan, Korea, United States, and Europe.

The investigators found no significant difference based on primary ER vs primary surgery for disease-specific survival (94.8% vs 96.5%; hazard ratio [HR], 1.09; 95% CI, 0.67-1.78) overall survival (79.6% vs 82.1%; HR, 1.10; 95% CI, 0.84-1.45), or recurrence-free survival (96.0% vs 96.7%; HR, 1.28; 95% CI, 0.87-1.88). Similarly, additional surgeries did not significantly improve recurrence-free survival when compared with primary surgeries (HR, 1.27; 95% CI, 0.85-1.89).

Clinical factors associated with recurrence of T1 CRC included lymphatic invasion, incomplete margins, and rectal cancer (HR, 2.67; 95% CI, 1.14-6.22), and high-risk histologic features, including lymphovascular invasion, were associated with lymph node metastasis (HR, 8.2; 95% CI, 3.65-18.4).

Adverse events were significantly lower (P <.001) in patients who underwent ER (2.3%) vs those who underwent surgery (10.9%).

The authors report the inability to include ER technique (ie, mucosal resection vs endoscopic submucosal dissection) into their analysis and follow-up time to be a limitation of the study. Although more than half of the included studies had a follow-up time of 60 months or longer, the overall median follow-up was 36 months. It remains unclear if recurrence rates differed at longer time scales.

According to these findings, ER should be considered first-line treatment for endoscopically resectable T1 CRC due to its comparable long-term recurrence and survival rates and significantly lower risk for adverse effects when compared with surgical intervention.

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Yeh J-H, Tseng C-H, Huang R-Y, et al. Long-term outcomes of primary endoscopic resection vs surgery for T1 colorectal cancer: a systemic review and meta-analysis [published online June 8, 2020]. Clin Gastroenterol Hepatol. doi:10.1016/j.cgh.2020.05.060