Long-term Outcomes of Primary Endoscopic Resection vs Surgery for T1 Colorectal Cancer: A Systematic Review and Meta-analysis

Yeh, Jen‐Hao; Tseng, Cheng‐Hao; Huang, Ruyi; Lin, Chih‐Wen; Lee, Ching‐Tai; Hsiao, Po‐Jen; Wu, Tsung‐Chin; Kuo, Liang‐Tseng; Wang, Wen‐Lun

doi:10.1016/j.cgh.2020.05.060

Cited by 29 publications

(34 citation statements)

References 38 publications

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“…For endoscopically treated high-risk T1 CRC, the recurrence rate was 7.0%, which is comparable with rates reported in surgically treated patients with T1 CRC. 86 We also observed that local and distant recurrences were found at comparable rates and that almost all recurrences occurred within 72 months after endoscopic resection. These findings suggest that monitoring of local and distant recurrences up to 6 years of follow-up should be considered for high-risk T1 CRCs.…”

Section: Discussionsupporting

confidence: 66%

Risk and Time Pattern of Recurrences After Local Endoscopic Resection of T1 Colorectal Cancer: A Meta-analysis

Dekkers

Cessie

Hooft

et al. 2022

Clinical Gastroenterology and Hepatology

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High-risk: 7.0% Low-risk: 0.7% BACKGROUND & AIMS:Growing numbers of patients with T1 CRC are being treated with local endoscopic resection only and as a result, the need for optimization of surveillance strategies for these patients also increases. We aimed to estimate the cumulative incidence and time pattern of CRC recurrences for endoscopically treated patients with T1 CRC. METHODS:Using a systematic literature search in PubMed, EMBASE, Web of Science and Cochrane Library (from inception till 15 May 2020), we identified and extracted data from studies describing the cumulative incidence of local or distant CRC recurrence for patients with T1 CRC treated with local endoscopic resection only. Pooled estimates were calculated using mixed-effect logistic regression models. RESULTS:Seventy-one studies with 5167 unique, endoscopically treated patients with T1 CRC were included. The pooled cumulative incidence of any CRC recurrence was 3.3% (209 events; 95% CI, 2.6%-4.3%; I 2 [ 54.9%), with local and distant recurrences being found at comparable rates (pooled incidences 1.9% and 1.6%, respectively). CRC-related mortality was observed in 42 out of 2519 patients (35 studies; pooled incidence 1.7%, 95% CI, 1.2%-2.2%; I 2 [ 0%), and the CRC-related mortality rate among patients with recurrence was 40.8% (42/103 patients). The vast majority of recurrences (95.6%) occurred within 72 months of follow-up. Pooled incidences of any CRC recurrence were 7.0% for high-risk T1 CRCs (28 studies; 95% CI, 4.9%-9.9%; I 2 [ 48.1%) and 0.7% (36 studies; 95% CI, 0.4%-1.2%; I 2 [ 0%) for low-risk T1 CRCs. CONCLUSIONS:Our meta-analysis provides quantitative outcome measures which are relevant to guidelines on surveillance after local endoscopic resection of T1 CRC.

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Section: Discussionsupporting

confidence: 66%

Risk and Time Pattern of Recurrences After Local Endoscopic Resection of T1 Colorectal Cancer: A Meta-analysis

Dekkers

Cessie

Hooft

et al. 2022

Clinical Gastroenterology and Hepatology

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“…This finding was consistent even after adjustments between the two groups for multiple patient and tumor factors 145 . This study contradicted a systematic review and meta-analysis that found that ER should be considered as the first-line treatment for endoscopically resectable T1 colorectal cancers, and that in cases of noncurative resection, additional surgery can have comparable outcomes to primary surgery 146 . Another study showed that for colonic neoplasms, laparoscopic surgery should be considered when ESD is technically difficult, but that for rectal neoplasms, ESD is desirable even for large-sized lesions 147 .…”

Section: Therapeutic Optionscontrasting

confidence: 68%

“…Weak recommendation, moderate quality evidence. colorectal cancers, and that in cases of noncurative resection, additional surgery can have comparable outcomes to primary surgery [146]. Another study showed that for colonic neoplasms, laparoscopic surgery should be considered when ESD is technically difficult, but that for rectal neoplasms, ESD is desirable even for large-sized lesions [147].…”

Section: Comparison With Surgerymentioning

confidence: 99%

Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022

Pimentel‐Nunes

Libânio

Bastiaansen³

et al. 2022

Endoscopy

293

212

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Main recommendationsESGE recommends that the evaluation of superficial gastrointestinal (GI) lesions should be made by an experienced endoscopist, using high definition white-light and chromoendoscopy (virtual or dye-based).ESGE does not recommend routine performance of endoscopic ultrasonography (EUS), computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET)-CT prior to endoscopic resection.ESGE recommends endoscopic submucosal dissection (ESD) as the treatment of choice for most superficial esophageal squamous cell and superficial gastric lesions.For Barrett’s esophagus (BE)-associated lesions, ESGE suggests the use of ESD for lesions suspicious of submucosal invasion (Paris type 0-Is, 0-IIc), for malignant lesions > 20 mm, and for lesions in scarred/fibrotic areas.ESGE does not recommend routine use of ESD for duodenal or small-bowel lesions.ESGE suggests that ESD should be considered for en bloc resection of colorectal (but particularly rectal) lesions with suspicion of limited submucosal invasion (demarcated depressed area with irregular surface pattern or a large protruding or bulky component, particularly if the lesions are larger than 20 mm) or for lesions that otherwise cannot be completely removed by snare-based techniques.ESGE recommends that an en bloc R0 resection of a superficial GI lesion with histology no more advanced than intramucosal cancer (no more than m2 in esophageal squamous cell carcinoma), well to moderately differentiated, with no lymphovascular invasion or ulceration, should be considered a very low risk (curative) resection, and no further staging procedure or treatment is generally recommended.ESGE recommends that the following should be considered to be a low risk (curative) resection and no further treatment is generally recommended: an en bloc R0 resection of a superficial GI lesion with superficial submucosal invasion (sm1), that is well to moderately differentiated, with no lymphovascular invasion, of size ≤ 20 mm for an esophageal squamous cell carcinoma or ≤ 30 mm for a stomach lesion or of any size for a BE-related or colorectal lesion, and with no lymphovascular invasion, and no budding grade 2 or 3 for colorectal lesions.ESGE recommends that, after an endoscopically complete resection, if there is a positive horizontal margin or if resection is piecemeal, but there is no submucosal invasion and no other high risk criteria are met, this should be considered a local-risk resection and endoscopic surveillance or re-treatment is recommended rather than surgery or other additional treatment.ESGE recommends that when there is a diagnosis of lymphovascular invasion, or deeper infiltration than sm1, or positive vertical margins, or undifferentiated tumor, or, for colorectal lesions, budding grade 2 or 3, this should be considered a high risk (noncurative) resection, and complete staging and strong consideration for additional treatments should be considered on an individual basis in a multidisciplinary discussion.ESGE recommends scheduled endoscopic surveillance with high definition white-light and chromoendoscopy (virtual or dye-based) with biopsies of only the suspicious areas after a curative ESD.

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“…Resection vs Surgery for T1 Colorectal Cancer: A Systematic Review and Meta-analysis T here is no consensus on the optimal treatment approach for stage T1 CRC. In this issue of Clinical Gastroenterology and Hepatology, Yeh et al 10 systematically reviewed the published literature on the comparative effectiveness of endoscopic resection vs surgery in improving outcomes in patients with T1 CRC. In a meta-analysis of 17 studies including more than 19,000 patients, there was no difference in the overall, disease-specific, and recurrence-free survival rates in patients treated with primary endoscopic resection vs surgery (Figure 3).…”

Section: Long-term Outcomes Of Primary Endoscopicmentioning

confidence: 99%

Issue Highlights

Kanwal

2020

Clinical Gastroenterology and Hepatology

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C olorectal cancer (CRC) incidence among individuals younger than age 50 is increasing. Recent guidelines recommended lowering the age of screening to 45 years for the general population, but this approach would add substantial cost to the healthcare system and be difficult to implement. 1 Further risk stratification may allow targeted screening to enhance the effectiveness and cost-effectiveness of CRC screening in individuals younger than 50. 2,3 In this issue of Clinical Gastroenterology and Hepatology, Gausman et al 4 compared a range of modifiable and nonmodifiable risk factors in 269 patients with early-onset CRC, 2802 with late-onset CRC, and 1122 age-matched controls. Most early-onset CRCs were sporadic, diagnosed at a late stage, and detected in the left colon or rectum.Male sex, family history of CRC, and personal history of inflammatory bowel disease were the key predictors of early-onset CRC compared with both age-matched controls and late-onset CRC cases. In addition, early-onset CRC patients were more likely to be black or Asian compared with late-onset CRC patients. Socioeconomic factors were not significantly associated with earlyonset CRC.These data show certain nonmodifiable risk factors contribute to early-onset CRC. These factors should be included in risk prediction models to facilitate targeted screening in individuals younger than age 50 while we wait for data on more granular predictors of earlyonset CRC that are measurable and readily available in the clinical setting (Figure 1).

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Long-term Outcomes of Primary Endoscopic Resection vs Surgery for T1 Colorectal Cancer: A Systematic Review and Meta-analysis

Cited by 29 publications

References 38 publications

Risk and Time Pattern of Recurrences After Local Endoscopic Resection of T1 Colorectal Cancer: A Meta-analysis

Risk and Time Pattern of Recurrences After Local Endoscopic Resection of T1 Colorectal Cancer: A Meta-analysis

Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022

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