Introduction Population-based bowel cancer screening has resulted in increasing numbers of patients with T1 colonic neoplasia. The need for colectomy in this group is questioned due to the low risk of lymphatic spread and increased treatment morbidity. This study examined the quality-of-life benefits and risks of local excision compared with results after colectomy, for low- and high-risk T1 colonic cancer.
Method Decision analysis using a Markov simulation model was performed: patients were managed with either local excision (advanced therapeutic endoscopy) or colectomy. Lesions were considered high-risk according to accepted national guidelines. Probabilities and utilities were derived from published data. Hypothetical cohorts of 65- and 80-year-old, fit and unfit patients, with low- or high-risk T1 colonic cancer were studied. The primary outcome was quality-adjusted life expectancy (QALE) in life-years (QALYs).
Results In low-risk T1 colonic neoplasia, local excision increases QALE by 2.72 QALYS for fit 65-year olds (15.5% increase over surgery) and by 0.93 for unfit 80-year-olds (20.9% increase). For high-risk T1 cancers, the QALE benefit for local excision is 1.82 QALYs for fit 65-year-olds (10.5% improvement) and 0.82 for unfit 80-year-olds (18.6% improvement). In sensitivity analysis, colectomy was only preferred for 65-year-old patients, when risk of recurrence following local excision exceeded 17.3%.
Conclusion Under a wide range of assumptions, for all patient cohorts, local excision is a reasonable treatment option for both low- and high-risk T1 colonic cancer. Exploration of methods to facilitate local excision of T1 colonic neoplasia appears warranted.
Disclosure of interest None Declared.