Prior endoscopic resection does not affect the outcome of secondary surgery for T1 colorectal cancer, a systematic review and meta-analysis

Nian, Jianhua; Tao, Liang; Zhou, Weiguang

doi:10.1007/s00384-021-04049-8

Cited by 8 publications

(5 citation statements)

References 34 publications

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“…In contrast, our results are in line with the previously mentioned meta-analysis that compared the morbidity of completion surgery after prior endoscopic resection to primary surgery [19]. This study showed that prior endoscopic resections did not appear to increase surgical morbidity.…”

Section: Discussionsupporting

confidence: 93%

“…Previous studies related to this topic have only reported outcomes of CS after ESD without comparing outcomes to a PS group [ 18 ], or reported outcomes of completion surgery after endoscopic resections in general [ 19 ]. Compared to the only other study reporting results of a cohort of patients undergoing CS following ESD, our overall adverse event rate of 24.1% in the CS-group appears to be slightly higher than the reported 17% [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

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Outcome of Completion Surgery after Endoscopic Submucosal Dissection in Early-Stage Colorectal Cancer Patients

Dekkers,

Dang,

Vork

et al. 2023

Cancers

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T1 colorectal cancers (T1CRC) are increasingly being treated by endoscopic submucosal dissection (ESD). After ESD of a T1CRC, completion surgery is indicated in a subgroup of patients. Currently, the influence of ESD on surgical morbidity and mortality is unknown. The aim of this study was to compare 90-day morbidity and mortality of completion surgery after ESD to primary surgery. The completion surgery group consisted of suspected T1CRC patients from a multicenter prospective ESD database (2014–2020). The primary surgery group consisted of pT1CRC patients from a nationwide surgical registry (2017–2019). Patients with rectal or sigmoidal cancers were selected. Patients receiving neoadjuvant therapy were excluded. Propensity score adjustment was used to correct for confounders. In total, 411 patients were included: 54 in the completion surgery group (39 pT1, 15 pT2) and 357 in the primary surgery group with pT1CRC. Adverse event rate was 24.1% after completion surgery and 21.3% after primary surgery. After completion surgery 90-day mortality did not occur, though one patient died in the primary surgery group. After propensity score adjustment, lymph node yield did not differ significantly between the groups. Among other morbidity-related outcomes, stoma rate (OR 1.298 95%-CI 0.587-2.872, p = 0.519) and adverse event rate (OR 1.162; 95%-CI 0.570-2.370, p = 0.679) also did not differ significantly. A subgroup analysis was performed in patients undergoing rectal surgery. In this subgroup (37 completion and 136 primary surgery), these morbidity outcomes also did not differ significantly. In conclusion, this study suggests that ESD does not compromise morbidity or 90-day mortality of completion surgery.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Outcome of Completion Surgery after Endoscopic Submucosal Dissection in Early-Stage Colorectal Cancer Patients

Dekkers,

Dang,

Vork

et al. 2023

Cancers

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“…If a rectal tumor is judged as benign or very superficial, a local resection will usually be attempted first (endoscopic or transanal) and only followed by major surgery if unsuccessful. It is well established that a previous attempt at local resection has no adverse effects on the outcome of a subsequent salvage operation [ 23 , 24 , 25 ]. ERUS as a supplement to MRI in imaging of early rectal tumors is, therefore, strongly recommended.…”

Section: Discussionmentioning

confidence: 99%

Endorectal Ultrasound Shear-Wave Elastography of Complex Rectal Adenoma and Early Rectal Cancer

et al. 2022

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Purpose: To investigate the diagnostic performance of endorectal ultrasound (ERUS), shear-wave elastography (SWE), and magnetic resonance imaging (MRI) in patients with a complex rectal adenoma or an early rectal cancer, i.e., T1 or T2 adenocarcinoma in a clinical setting, and to evaluate the association between SWE and stromal fraction (SF) and apparent diffusion coefficient (ADC) and SF. Method: This prospective study included patients undergoing ERUS and SWE for a rectal tumor subsequently confirmed by histopathology to be an adenoma or a T1 or T2 adenocarcinoma. The accuracy of the imaging methods was assessed by comparing the T category as determined by ERUS and MRI with histopathology, which served as the gold standard. SF was assessed on surgical specimens. Results: A total of 86 patients were included. Of these, 62 patients had adenomas and 24 patients had carcinomas, of which 11 were T1 tumors and 13 were T2 tumors. ERUS and MRI yielded sensitivity, specificity, and accuracy of 0.79 and 0.73, 0.95 and 0.90, and 0.86 and 0.78, respectively, for discrimination between benign and malignant lesions. The area under the receiver operating characteristics curve for SWE was 0.88, and with a cut-off value of 40 kPa the sensitivity, specificity, and accuracy were 0.79, 0.89, and 0.86, respectively. There was a positive correlation between SF and SWE with a p-value of <0.001 and a negative correlation between SF and ADC with a p-value of 0.011. Conclusion: Both ERUS and MRI classified T categories with a high accuracy; however, ERUS classified more adenomas correctly than MRI. In this small population, SWE could differentiate an adenoma from early carcinoma. SF was correlated with both SWE and ADC, as increasing SF tended to yield higher SWE and lower ADC values.

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“…According to recent evidence, it is becoming clear that endoscopic treatment before surgery does not affect outcomes in high-risk patients regarding survival, recurrence, and postoperative complications [ 38 , 39 ], but it is unclear whether surgery reduces recurrence and mortality from pT1 CRC. Several studies suggest that recurrence and disease-free survival do not change with the treatment modality performed.…”

Section: Crc Pt1 Survival Appears To Depend On Histology Not Treatmentmentioning

confidence: 99%

Dilemmas in the Clinical Management of pT1 Colorectal Cancer

Zaffalon

Daca‐Alvarez

Gordoa

et al. 2023

Cancers

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Implementation of population-based colorectal cancer screening programs has led to increases in the incidence of pT1 colorectal cancer. These incipient invasive cancers have a very good prognosis and can be treated locally, but more than half of these cases are treated with surgery due to the presence of histological high-risk criteria. These high-risk criteria are suboptimal, with no consensus among clinical guidelines, heterogeneity in definitions and assessment, and poor concordance in evaluation, and recent evidence suggests that some of these criteria considered high risk might not necessarily affect individual prognosis. Current criteria classify most patients as high risk with an indication for additional surgery, but only 2–10.5% have lymph node metastasis, and the residual tumor is present in less than 20%, leading to overtreatment. Patients with pT1 colorectal cancer have excellent disease-free survival, and recent evidence indicates that the type of treatment, whether endoscopic or surgical, does not significantly impact prognosis. As a result, the protective role of surgery is questionable. Moreover, surgery is a more aggressive treatment option, with the potential for higher morbidity and mortality rates. This article presents a comprehensive review of recent evidence on the clinical management of pT1 colorectal cancer. The review analyzes the limitations of histological evaluation, the prognostic implications of histological risk status and the treatment performed, the adverse effects associated with both endoscopic and surgical treatments, and new advances in endoscopic treatment.

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Prior endoscopic resection does not affect the outcome of secondary surgery for T1 colorectal cancer, a systematic review and meta-analysis

Cited by 8 publications

References 34 publications

Outcome of Completion Surgery after Endoscopic Submucosal Dissection in Early-Stage Colorectal Cancer Patients

Outcome of Completion Surgery after Endoscopic Submucosal Dissection in Early-Stage Colorectal Cancer Patients

Endorectal Ultrasound Shear-Wave Elastography of Complex Rectal Adenoma and Early Rectal Cancer

Dilemmas in the Clinical Management of pT1 Colorectal Cancer

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