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

Abstract

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.

Tumor Location as a Prognostic Factor in T1 Colorectal Cancer

“…There is a consensus from most studies that rectal T1 cancer presents a higher recurrence rate than colon T1 cancer, regardless of the treatment strategy [43][44][45][46][47]. In a single-center study of 930 T1 CRC patients, Kouyama et al reported that rectal location was a significant risk factor for recurrence in the total population, including endoscopic resection alone and surgical resection.…”

“…Yoda et al and Yoshii et al reported a similar tendency (rectum, 9.9% (10/101) and 14.5% (8/55); colon, 1.5% (5/ 327) and 2.3% (9/323), respectively) [44,45]. In 2020, a meta-analysis of 11 studies by Dang et al revealed that the rectal cancer also indicated a higher recurrence rate than the colon cancer (colon, 0.8%, 95%CI 0.2-2.8; rectum, 5.7%, 95% CI 2.0-15.2) [47]. Finally, Ikematsu et al investigated the recurrence rate between the colon and rectum dividing 758 T1 CRC patients into two groups according to the LNM risk in a multicenter study [46].…”

Surgical rather than endoscopic resection of early-stage colorectal cancers promotes excessive imaging surveillance

“…There exists no literature on the benefit of sequential imaging over time. Two recent meta-analyses showed that the cumulative incidence of distal cancer recurrence was 3.5% and 5.5% after the endoscopic resection of high-risk T1 carcinomas [22,23]. The present study demonstrates the poor performance of monitoring, with only one case of metastasis detected and four missed diagnoses among the 121 patients with T1 cancers followed up by imaging.…”

“…Nevertheless, some authors continue to believe that patients with high-risk T1 CRC should be offered personalized surveillance through shared decision-making while also taking into account the physical status and life expectancy of the patient [23]. For this reason, the issue of imaging surveillance should be discussed in multidisciplinary tumor meetings, which was not the case in this study, where only one third of the patient charts were presented to discuss only therapeutic management.…”

Relevance of polyp size for primary endoscopic full-thickness resection of suspected T1 colorectal cancers

“…Paul Didden, MD, PhD 1 Rixta A.H. van Eijck van Heslinga, BSc 1 , Matthijs P. Schwartz, MD, PhD 2 , L.R. Arensman, MD 3 , Frank P. Vleggaar, MD, PhD 1 , Wilmar de Graaf, MD, PhD 4 , Arjun D. Koch, MD, PhD 4 , Michael. Doukas, MD, PhD 5 , Miangela M. Lacle, MD, PhD 6 , Leon M.G.…”