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DOI: 10.1055/a-1814-4434
Risk of recurrence after endoscopic resection of nonpedunculated T1 colorectal cancer
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Abstract
Background The long-term outcome after local excision of T1 colorectal cancer (CRC) remains unknown. The aim of this study was to examine clinical and histopathological risk factors for recurrence in patients with T1 CRC undergoing endoscopic resection.
Methods This was a retrospective registry-based population study on prospectively collected data of all patients with nonpedunculated T1 CRC undergoing only local excision (no salvage surgery) in Sweden between 2009 and 2018. Potential risk factors for recurrence, including age, sex, tumor location, resection margins, lymphovascular, perineural, and submucosal invasion, grade of differentiation, and mucinous subtype, were analyzed using univariate and multivariate cox regression.
Results Median follow-up time was 60 months, and 28 /602 patients (4.7 %) had a recurrence (13 local and 18 distant). Recurrence rate stratified by submucosal invasion was: Sm1 3.5 % (14 /397), Sm2 6.0 % (8 /133), and Sm3 8.3 % (6 /72), with no significant differences. Resection margins, lymphovascular and perineural invasion, grade of differentiation, mucinous subtype, and age were not significant risk factors for recurrence. In contrast, rectal location was found to be a significant risk factor for tumor recurrence in multivariate analysis (hazard ratio 3.08, P = 0.006). The 3– and 5-year disease-free survival was 96.2 % and 91.1 %, respectively, in T1 CRC patients undergoing endoscopic resection.
Conclusion Tumor recurrence was rare (4.7 %) in this large population-based study on recurrence after local excision of nonpedunculated T1 CRC. Rectal location was an independent risk factor for recurrence, suggesting the need for strict surveillance after endoscopic resection of early rectal cancer.
Publication History
Received: 24 August 2021
Accepted after revision: 25 February 2022
Article published online:
04 May 2022
© 2022. Thieme. All rights reserved.
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References
- 1 Yamamoto S, Watanabe M, Hasegawa H. et al. The risk of lymph node metastasis in T1 colorectal carcinoma. Hepatogastroenterology 2004; 51: 998-1000
- 2 Suh JH, Han KS, Kim BC. et al. Predictors for lymph node metastasis in T1 colorectal cancer. Endoscopy 2012; 44: 590-595
- 3 Nascimbeni R, Burgart LJ, Nivatvongs S. et al. Risk of lymph node metastasis in T1 carcinoma of the colon and rectum. Dis Colon Rectum 2002; 45: 200-206
- 4 Huh JW, Kim HR, Kim YJ. Lymphovascular or perineural invasion may predict lymph node metastasis in patients with T1 and T2 colorectal cancer. J Gastrointest Surg 2010; 14: 1074-1080
- 5 Rönnow CF, Arthursson V, Toth E. et al. Lymphovascular infiltration, not depth of invasion, is the critical risk factor of metastases in early colorectal cancer: retrospective population-based cohort study on prospectively collected data, including validation. Ann Surg 2022; 275: e148-e154
- 6 Watanabe T, Itabashi M, Shimada Y. et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines 2014 for treatment of colorectal cancer. Int J Clin Oncol 2015; 20: 207-239
- 7 Nakadoi K, Tanaka S, Kanao H. et al. Management of T1 colorectal carcinoma with special reference to criteria for curative endoscopic resection. J Gastroenterol Hepatol 2012; 27: 1057-1062
- 8 Iguchi K, Mushiake H, Aoyama T. et al. Additional surgical resection after endoscopic resection for patients with high-risk T1 colorectal cancer. In Vivo 2019; 33: 1243-1248
- 9 Bosch SL, Teerenstra S, de Wilt JH. et al. Predicting lymph node metastasis in pT1 colorectal cancer: a systematic review of risk factors providing rationale for therapy decisions. Endoscopy 2013; 45: 827-834
- 10 Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T. et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47: 829-854
- 11 Ha RK, Han KS, Sohn DK. et al. Histopathologic risk factors for lymph node metastasis in patients with T1 colorectal cancer. Ann Surg Treat Res 2017; 93: 266-271
- 12 Levic K, Bulut O, Hansen TP. et al. Malignant colorectal polyps: endoscopic polypectomy and watchful waiting is not inferior to subsequent bowel resection. A nationwide propensity score-based analysis. Langenbecks Arch Surg 2019; 404: 231-242
- 13 Zauber AG, Winawer SJ, O’Brien MJ. et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012; 366: 687-696
- 14 Sohn DK, Chang HJ, Park JW. et al. Histopathological risk factors for lymph node metastasis in submucosal invasive colorectal carcinoma of pedunculated or semipedunculated type. J Clin Pathol 2007; 60: 912-915
- 15 Dixon MF. Gastrointestinal epithelial neoplasia: Vienna revisited. Gut 2002; 51: 130-131
- 16 Belderbos TD, van Erning FN, de Hingh IH. et al. Long-term recurrence-free survival after standard endoscopic resection versus surgical resection of submucosal invasive colorectal cancer: a population-based study. Clin Gastroenterol Hepatol 2017; 15: 403-411
- 17 Kouyama Y, Kudo SE, Miyachi H. et al. Risk factors of recurrence in T1 colorectal cancers treated by endoscopic resection alone or surgical resection with lymph node dissection. Int J Colorectal Dis 2018; 33: 1029-1038
- 18 Tamaru Y, Oka S, Tanaka S. et al. Long-term outcomes after treatment for T1 colorectal carcinoma: a multicenter retrospective cohort study of Hiroshima GI Endoscopy Research Group. J Gastroenterol 2017; 52: 1169-1179
- 19 Kudo S. Endoscopic mucosal resection of flat and depressed types of early colorectal cancer. Endoscopy 1993; 25: 455-461
- 20 Schlemper RJ, Riddell RH, Kato Y. et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut 2000; 47: 251-255
- 21 Kouyama Y, Kudo SE, Miyachi H. et al. Practical problems of measuring depth of submucosal invasion in T1 colorectal carcinomas. Int J Colorectal Dis 2016; 31: 137-146
- 22 Kim JB, Lee HS, Lee HJ. et al. Long-term outcomes of endoscopic versus surgical resection of superficial submucosal colorectal cancer. Dig Dis Sci 2015; 60: 2785-2792
- 23 Asayama N, Oka S, Tanaka S. et al. Long-term outcomes after treatment for T1 colorectal carcinoma. Int J Colorectal Dis 2016; 31: 571-578
- 24 Kikuchi R, Takano M, Takagi K. et al. Management of early invasive colorectal cancer. Risk of recurrence and clinical guidelines. . Dis Colon Rectum 1995; 38: 1286-1295
- 25 Ikematsu H, Yoda Y, Matsuda T. et al. Long-term outcomes after resection for submucosal invasive colorectal cancers. Gastroenterology 2013; 144: 551-559
- 26 Yoda Y, Ikematsu H, Matsuda T. et al. A large-scale multicenter study of long-term outcomes after endoscopic resection for submucosal invasive colorectal cancer. Endoscopy 2013; 45: 718-724
- 27 Hashiguchi Y, Muro K, Saito Y. et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol 2020; 25: 1-42
- 28 Park EY, Baek DH, Lee MW. et al. Long-term outcomes of T1 colorectal cancer after endoscopic resection. J Clin Med 2020; 9: 2451
- 29 Overwater A, Kessels K, Elias SG. et al. Endoscopic resection of high-risk T1 colorectal carcinoma prior to surgical resection has no adverse effect on long-term outcomes. Gut 2018; 67: 284-290
- 30 Yoshii S, Nojima M, Nosho K. et al. Factors associated with risk for colorectal cancer recurrence after endoscopic resection of T1 tumors. Clin Gastroenterol Hepatol 2014; 12: 292-302
- 31 Baré M, Mora L, Pera M. et al. Type and consequences of short-term complications in colon cancer surgery, focusing on the oldest old. Clin Colorectal Cancer 2020; 19: e18-e25
- 32 Alves A, Panis Y, Mathieu P. et al. Postoperative mortality and morbidity in French patients undergoing colorectal surgery: results of a prospective multicenter study. Arch Surg 2005; 140: 278-284
- 33 Sun J, Jiang T, Qiu Z. et al. Short-term and medium-term clinical outcomes of laparoscopic-assisted and open surgery for colorectal cancer: a single center retrospective case-control study. BMC Gastroenterol 2011; 11: 85
- 34 Kitajima K, Fujimori T, Fujii S. et al. Correlations between lymph node metastasis and depth of submucosal invasion in submucosal invasive colorectal carcinoma: a Japanese collaborative study. J Gastroenterol 2004; 39: 534-543
- 35 Oka S, Tanaka S, Nakadoi K. et al. Risk analysis of submucosal invasive rectal carcinomas for lymph node metastasis to expand indication criteria for endoscopic resection. Dig Endosc 2013; 25 (Suppl. 02) 21-25
- 36 Shin JW, Han KS, Hyun JH. et al. Risk of recurrence after endoscopic resection of early colorectal cancer with positive margins. Endoscopy 2018; 50: 241-247
- 37 Komeda Y, Watanabe T, Sakurai T. et al. Risk factors for local recurrence and appropriate surveillance interval after endoscopic resection. World J Gastroenterol 2019; 25: 1502-1512