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. 2023 Feb;37(2):1231-1241.
doi: 10.1007/s00464-022-09649-1. Epub 2022 Sep 28.

Long-term outcomes after endoscopic versus surgical resection of T1 colorectal carcinoma

Hyun Jin Bae  1 , Hoyeon Ju  2 , Han Hee Lee  3 , Jinsu Kim  4 , Bo-In Lee  2 , Sung Hak Lee  5 , Daeyoun David Won  6 , Yoon Suk Lee  6 , In Kyu Lee  6 , Young-Seok Cho  7
Affiliations

Long-term outcomes after endoscopic versus surgical resection of T1 colorectal carcinoma

Hyun Jin Bae et al. Surg Endosc. 2023 Feb.

Abstract

Background: The long-term outcomes of patients with T1 colorectal cancer (CRC) who undergo endoscopic and/or surgical treatment are not well understood. Invasive CRC confined to the colonic submucosa (T1 CRC) is challenging in terms of clinical decision-making. We compared the long-term outcomes of T1 CRC by treatment method.

Methods: We examined 370 patients with pathological T1 CRC treated between 2000 and 2015 at Seoul St. Mary's Hospital. In total, 93 patients underwent endoscopic resection (ER) only, 82 underwent additional surgery after ER, and 175 underwent surgical resection only. Patients who did not meet the curative criteria were defined as "high-risk." High-risk patients were classified into three groups according to the treatment modalities: ER only (Group A: 35 patients), additional surgery after ER (Group B: 72 patients), and surgical resection only (Group C: 133 patients). The recurrence-free and overall survival (OS) rates, and factors associated with recurrence and mortality, were analyzed. Factors associated with lymph node metastasis (LNM) were subjected to multivariate analysis.

Results: Of the 370 patients, 7 experienced recurrence and 7 died. All recurrences occurred in the high-risk group and two deaths were in the low-risk group. In high-risk groups, there was no significant group difference in recurrence-free survival (P = 0.511) or OS (P =0.657). Poor histology (P =0.042) was associated with recurrence, and vascular invasion (P =0.044) with mortality. LNMs were observed in 30 of 277 patients who underwent surgery either initially or secondarily. Lymphatic invasion was significantly associated with the incidence of LNM (P < 0.001).

Conclusions: ER prior to surgery did not affect the prognosis of high-risk T1 CRC patients, and did not worsen the clinical outcomes of patients who required additional surgery. Lymphatic invasion was the most important predictor of LNM.

Keywords: Colorectal neoplasms; Lymphatic metastasis; Survival rate; Treatment outcome.

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