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Long-term outcomes of additional surgery after endoscopic resection versus primary surgery for T1 colorectal cancer

2024; Lippincott Williams & Wilkins; Linguagem: Inglês

10.14309/ajg.0000000000002879

1572-0241

Yuzuru Tamaru, Toshio Kuwai, Yoshiki Kajiwara, Shiro Oka, Shôichi Saito, Yosuke Fukunaga, Hiroshi Kawachi, Manabu Takamatsu, Kinichi Hotta, Hiroaki Ikematsu, Motohiro Kojima, Yutaka Saito, Yukihide Kanemitsu, Masayoshi Yamada, Shigeki Sekine, Shinji Tanaka, Shinji Nagata, Takahiro Nakamura, Kazutaka Yamada, Maki Konno, Soichiro Ishihara, Yusuke Saitoh, Kenji Matsuda, Kazutomo Togashi, Koji Komori, Megumi Ishiguro, Takashi Okuyama, Akihiro Ohuchi, Shinobu Ohnuma, Kazuhiro Sakamoto, Tamotsu Sugai, Kenji Katsumata, Hiro‐o Matsushita, Hiro‐o Yamano, Keisuke Nakai, Toshio Uraoka, Naohiko Akimoto, Hirotoshi Kobayashi, Yoichi Ajioka, Kenichi Sugihara, Hideki Ueno,

Colorectal Cancer Screening and Detection

INTRODUCTION: There is considerable concern about whether endoscopic resection (ER) before additional surgery (AS) for T1 colorectal cancer (CRC) has oncologically potential adverse effects. Therefore, the aim of this study was to compare the long-term outcomes, including overall survival (OS), of patients treated with AS after ER vs primary surgery (PS) for T1 CRC using a propensity score-matched analysis from a large observational study. METHODS: This study investigated 6,105 patients with T1 CRC treated with either ER or surgical resection between 2009 and 2016 at 27 high-volume Japanese institutions, with those undergoing surgery alone included in the PS group and those undergoing AS after ER included in the AS group. Propensity score matching was used for long-term outcomes of mortality and recurrence analysis. RESULTS: After propensity score matching, 1,219 of 2,438 patients were identified in each group. The 5-year OS rates in the AS and PS groups were 97.1% and 96.0%, respectively (hazard ratio: 0.72, 95% confidence interval: 0.49–1.08), indicating the noninferiority of the AS group. Moreover, 32 patients (2.6%) in the AS group and 24 (2.0%) in the PS group had recurrences, with no significant difference between the 2 groups (odds ratio: 1.34, 95% confidence interval: 0.76–2.40, P = 0.344). DISCUSSION: ER before AS for T1 CRC had no adverse effect on patients' long-term outcomes, including the 5-year OS rate. ER is a viable first-line treatment option for endoscopically resectable T1 CRC.