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.
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