Long-term outcomes after treatment for T1 colorectal carcinoma: a multicenter retrospective cohort study of Hiroshima GI Endoscopy Research Group

Tamaru, Yuzuru; Oka, Shiro; Tanaka, Shinji; Nagata, Shinji; Hiraga, Yoshikazu; Kuwai, Toshio; Furudoi, Akira; Tamura, Tadamasa; Kitajima, Masaki; Okanobu, Hideharu; Nakadoi, Koichi; Kanao, Hiroyuki; Higashiyama, Makoto; Arihiro, Koji; Kuraoka, Kazuya; Shimamoto, Fumio; Chayama, Kazuaki

doi:10.1007/s00535-017-1318-1

Cited by 76 publications

(66 citation statements)

References 35 publications

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“…More recently, in a retrospective multicenter cohort study in Japan, the primary surgery and secondary surgery groups exhibited recurrence rates of 5.5% and 3.8%, respectively, and overall survival rates of 92.4% and 91.5%, respectively. These studies supported the hypothesis that endoscopic resection for T1 CRC did not worsen clinical outcomes for patients who required additional surgical resection (8). Importantly, Overwater et al reported a total of 16 treatment-related complications leading to death within 30 days after treatment; 15 of these complications were related to surgery (9 leakages, 5 cardiovascular, and 1 abscess), and only one complication was related to endoscopy.…”

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confidence: 59%

“…Importantly, Overwater et al reported a total of 16 treatment-related complications leading to death within 30 days after treatment; 15 of these complications were related to surgery (9 leakages, 5 cardiovascular, and 1 abscess), and only one complication was related to endoscopy. Currently, population aging is occurring throughout Japan, and we should consider a patient's age, wishes, performance status, and quality of life, as well as the operative method (8). Therefore, the indication for endoscopic resection for T1 CRC will be expanded to total excisional biopsy, particularly for limited patients (e.g., patients who are elderly, have concomitant disease, or are restricted with respect to operative method or performance status, among other considerations) in the near future (9).…”

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confidence: 99%

“…In both the primary and secondary groups, distant metastasis occurred in the liver (n=13), lungs (n=11), and peritoneum (n=7). Generally, CRC requires a relatively long time to recur, and approximately 90% of instances of recurrence after curative resection of CRC occur within 5 years of surgery (8,10). However, recurrences have occurred after more than 5 years in a few cases.…”

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confidence: 99%

“…However, recurrences have occurred after more than 5 years in a few cases. Therefore, follow-up examinations are typically required for at least 5 years (6,8,11). Additionally, recommendations suggest performing blood tests, including assessments of carcinoembryonic antigen level, chest radiography examinations, and computed tomography of the abdomen and pelvis every 6 months for the first 3 postoperative years and every 12 months thereafter (12).…”

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confidence: 99%

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Endoscopic treatment for high-risk T1 colorectal cancer: is it better to begin with endoscopic or surgical treatment?

Fujihara

Mori

Kobara

et al. 2017

Transl. Gastroenterol. Hepatol.

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We read with interest the article "Endoscopic resection of high-risk T1 colorectal carcinoma prior to surgical resection has no adverse effect on long-term outcomes" by Overwater et al., which was published in Gut (1). Endoscopic resection, including polypectomy and endoscopic mucosal resection (EMR), is a widely recognized treatment for early gastrointestinal malignancies. Endoscopic submucosal dissection (ESD) is accepted as a minimally invasive treatment for early-stage colorectal cancer (CRC), and this approach enables en bloc resection of a specimen (2). In certain cases, endoscopic treatment alone is insufficient for disease control, and additional surgical treatment after EMR is recommended for patients with high-risk T1 CRC (3,4). However, endoscopic resection of T1 CRC prior to surgical resection might worsen oncologic outcomes by accelerating the growth of the remaining tumor and promoting cancer cell dissemination and metastasis. For high-risk T1 CRC, relatively little is known about whether endoscopic resection before surgery influences lymph node metastasis (LNM), recurrence, or long-term survival.Prior studies showed that the recurrence rate of endoscopically treated T1 CRC is 2.3-7.3% and that the duration of recurrence is 19.7-38.3 months (3,5-7). Asayama et al. reported recurrence rates of 4.3% and 6.6% in primary surgery and secondary surgery (endoscopic resection with additional surgical resection) groups, respectively, although this difference was not significant (7). However, previous investigations have exhibited several limitations, including the examination of a small number of patients, short follow-up periods, and a lack of data regarding pathological findings.The aforementioned study by Overwater et al. was the largest multicenter observational study to evaluate longterm outcomes after surgical resection of high-risk T1 CRC with or without prior endoscopic resection in Western countries. This retrospective study involved 602 patients diagnosed with T1 CRC with one or more histological risk factors for LNM who were treated via primary or secondary surgery between 2000 and 2014 at 13 hospitals in the Netherlands. High-risk T1-CRC was defined as CRC with poorly differentiated histology, positive resection margins, deep submucosal invasion depth (defined as a submucosal invasion depth ≥1,000 μm, Sm2/Sm3 stage for sessile T1 CRC and Haggitt level 3-4 for pedunculated T1 CRC) or the presence of vascular or lymphatic invasion. The present study is particularly important because it was limited to analyzing high-risk T1 CRC for both primary surgical resection and secondary surgical resection (endoscopic resection with additional surgical resection). No differences were observed between primary and secondary surgery with respect to the presence of LNM (OR 0.97; 95% CI: 0.49 to 1.93; P=0.94) or recurrence during followup (HR 0.97; 95% CI: 0.41 to 2.34; P=0.954). In the aforementioned study by Overwater et al., recurrence rates Editorial

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confidence: 59%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Endoscopic treatment for high-risk T1 colorectal cancer: is it better to begin with endoscopic or surgical treatment?

Fujihara

Mori

Kobara

et al. 2017

Transl. Gastroenterol. Hepatol.

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“…A recent Japanese report examined T1 CRC patients treated during 1992-2008 and who had ≥5 years of followup (6). Patients who did not meet the curative criteria after endoscopic resection according to the JSCCR guidelines were defined as "non-endoscopically curable" and classified into three groups: endoscopic resection alone, additional surgery after endoscopic resection, and surgical resection alone.…”

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confidence: 99%

Incomplete resection after macroscopic radical endoscopic resection of T1 colorectal cancer—should a paradigm-changing approach to address the risk be considered?

Leung

2017

Transl. Gastroenterol. Hepatol.

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Local recurrence after local excision of early rectal cancer: a meta-analysis of completion TME, adjuvant (chemo)radiation, or no additional treatment

Oostendorp

Smits

Vroom

et al. 2020

British Journal of Surgery

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Background: The risks of local recurrence and treatment-related morbidity need to be balanced after local excision of early rectal cancer. The aim of this meta-analysis was to determine oncological outcomes after local excision of pT1-2 rectal cancer followed by no additional treatment (NAT), completion total mesorectal excision (cTME) or adjuvant (chemo)radiotherapy (aCRT). Methods: A systematic search was conducted in PubMed, Embase and the Cochrane Library. The primary outcome was local recurrence. Statistical analysis included calculation of the weighted average of proportions. Results: Some 73 studies comprising 4674 patients were included in the analysis. Sixty-two evaluated NAT, 13 cTME and 28 aCRT. The local recurrence rate for NAT among low-risk pT1 tumours was 6⋅7 (95 per cent c.i. 4⋅8 to 9⋅3) per cent. There were no local recurrences of low-risk pT1 tumours after cTME or aCRT. The local recurrence rate for high-risk pT1 tumours was 13⋅6 (8⋅0 to 22⋅0) per cent for local excision only, 4⋅1 (1⋅7 to 9⋅4) per cent for cTME and 3⋅9 (2⋅0 to 7⋅5) per cent for aCRT. Local recurrence rates for pT2 tumours were 28⋅9 (22⋅3 to 36⋅4) per cent with NAT, 4 (1 to 13) per cent after cTME and 14⋅7 (11⋅2 to 19⋅0) per cent after aCRT. Conclusion: There is a substantial risk of local recurrence in patients who receive no additional treatment after local excision, especially those with high-risk pT1 and pT2 rectal cancer. The lowest recurrence risk is provided by cTME; aCRT has outcomes comparable to those of cTME for high-risk pT1 tumours, but shows a higher risk for pT2 tumours.

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Long-term outcomes after treatment for T1 colorectal carcinoma: a multicenter retrospective cohort study of Hiroshima GI Endoscopy Research Group

Abstract: Our findings supported the JSCCR criteria for endoscopically curable T1 CRC. ER for T1 CRC did not worsen the clinical outcomes of patients who required additional surgical resection.

Cited by 76 publications

References 35 publications

Endoscopic treatment for high-risk T1 colorectal cancer: is it better to begin with endoscopic or surgical treatment?

Endoscopic treatment for high-risk T1 colorectal cancer: is it better to begin with endoscopic or surgical treatment?

Incomplete resection after macroscopic radical endoscopic resection of T1 colorectal cancer—should a paradigm-changing approach to address the risk be considered?

Local recurrence after local excision of early rectal cancer: a meta-analysis of completion TME, adjuvant (chemo)radiation, or no additional treatment

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