RT Journal Article
SR Electronic
T1 Endoscopic resection of high-risk T1 colorectal carcinoma prior to surgical resection has no adverse effect on long-term outcomes
JF Gut
JO Gut
FD BMJ Publishing Group Ltd and British Society of Gastroenterology
SP 284
OP 290
DO 10.1136/gutjnl-2015-310961
VO 67
IS 2
A1 A Overwater
A1 K Kessels
A1 S G Elias
A1 Y Backes
A1 B W M Spanier
A1 T C J Seerden
A1 H J M Pullens
A1 W H de Vos tot Nederveen Cappel
A1 A van den Blink
A1 G J A Offerhaus
A1 J van Bergeijk
A1 M Kerkhof
A1 J M J Geesing
A1 J N Groen
A1 N van Lelyveld
A1 F ter Borg
A1 F Wolfhagen
A1 P D Siersema
A1 M M Lacle
A1 L M G Moons
A1 ,
YR 2018
UL http://gut.bmj.com/content/67/2/284.abstract
AB Objective It is difficult to predict the presence of histological risk factors for lymph node metastasis (LNM) before endoscopic treatment of T1 colorectal cancer (CRC). Therefore, endoscopic therapy is propagated to obtain adequate histological staging. We examined whether secondary surgery following endoscopic resection of high-risk T1 CRC does not have a negative effect on patients' outcomes compared with primary surgery.Design Patients with T1 CRC with one or more histological risk factors for LNM (high risk) and treated with primary or secondary surgery between 2000 and 2014 in 13 hospitals were identified in the Netherlands Cancer Registry. Additional data were collected from hospital records, endoscopy, radiology and pathology reports. A propensity score analysis was performed using inverse probability weighting (IPW) to correct for confounding by indication.Results 602 patients were eligible for analysis (263 primary; 339 secondary surgery). Overall, 34 recurrences were observed (5.6%). After adjusting with IPW, no differences were observed between primary and secondary surgery for the presence of LNM (OR 0.97; 95% CI 0.49 to 1.93; p=0.940) and recurrence during follow-up (HR 0.97; 95% CI 0.41 to 2.34; p=0.954). Further adjusting for lymphovascular invasion, depth of invasion and number of retrieved lymph nodes did not alter this outcome.Conclusions Our data do not support an increased risk of LNM or recurrence after secondary surgery compared with primary surgery. Therefore, an attempt for an en-bloc resection of a possible T1 CRC without evident signs of deep invasion seems justified in order to prevent surgery of low-risk T1 CRC in a significant proportion of patients.