Long-term prognostic outcomes in high-risk T1 colorectal cancer: A multicentre retrospective comparison of surgery versus observation postendoscopic treatment

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease Pub Date : 2025-01-06 DOI:10.1111/codi.17269

Yosuke Atsumi, Masakatsu Numata, Jun Watanabe, Atsuhiko Sugiyama, Atsushi Ishibe, Yuichiro Ozeki, Kingo Hirasawa, Keiichi Ashikari, Takuma Higurashi, Akio Higuchi, Shinpei Kondo, Naoya Okada, Hideyuki Chiba, Hirokazu Suwa, Hiroaki Kaneko, Kanji Okuma, Teni Godai, Itaru Endo, Shin Maeda, Atsushi Nakajima, Yasushi Rino, Aya Saito

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引用次数: 0

Abstract

Aim

The risk of lymph node metastasis after endoscopic resection of high-risk T1 colorectal cancer prompts additional resection. However, age and comorbidities are considered in decision-making and some surgeons opt for observation. We compared the long-term outcomes of these approaches with the aim of clarifying the need for additional resection.

Method

This multicentre retrospective study included high-risk T1 colorectal cancer patients treated with endoscopic submucosal dissection (ESD) between January 2013 and April 2021. Patients who met one or more of the following criteria were eligible for inclusion: submucosal invasion depth ≥1000 μm, vessel invasion, poor differentiation, budding grade 2/3 or a positive vertical margin. Patients were divided into resection (R) and observation (O) groups. Outcomes were evaluated based on overall survival (OS) and 5-year cancer-specific survival (CSS), with an additional stratified analysis using the age-adjusted Charlson comorbidity index (ACCI).

Results

The study included 178 patients (group R, n = 131; group O, n = 47). Patients in group O were significantly older and had more comorbidities. Group R showed better 5-year OS and CSS (OS 87.0% vs. 58.9%, p = 0.001; CSS 98.8% vs. 78.4%, p = 0.002). Stratification by ACCI revealed that benefits of additional resection remained for patients with ACCI ≤ 6 (OS 91.2% vs. 58.3%, p = 0.013; CSS 98.4% vs. 61.7%, p < 0.001) but not for those with ACCI ≥7 (OS 75.9% vs. 59.8%, p = 0.289; CSS 100% vs. 100%, p = 0.617).

Conclusions

Significant survival benefits were demonstrated in group R patients with high-risk T1 cancer. However, the survival benefit of additional surgical resection was unconfirmed in patients with ACCI ≥ 7.

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来源期刊

Colorectal Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

11.80%

发文量

406

审稿时长

1.5 months

期刊介绍： Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate. Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases. Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies. Note that the journal does not usually accept paediatric surgical papers.