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. 2023 Sep 9;15(18):4490.
doi: 10.3390/cancers15184490.

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

Nik Dekkers  1 , Hao Dang  1 , Katinka Vork  1 , Alexandra M J Langers  1 , Jolein van der Kraan  1 , Marinke Westerterp  2 , Koen C M J Peeters  3 , Fabian A Holman  3 , Arjun D Koch  4 , Wilmar de Graaf  4 , Paul Didden  5 , Leon M G Moons  5 , Pascal G Doornebosch  6 , James C H Hardwick  1 , Jurjen J Boonstra  1
Affiliations

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

Nik Dekkers et al. Cancers (Basel). .

Abstract

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.

Keywords: T1CRC; colorectal cancer; completion surgery; endoscopic submucosal dissection; morbidity; nationwide database; total mesorectal excision.

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Conflict of interest statement

Leon M. G. Moons is a consultant for Boston Scientific. This disclosure does not directly relate to the content of this work. All other authors declare that they have no competing interest.

Figures

Figure 1
Figure 1
Flow diagram of patient selection. ESD, endoscopic submucosal dissection; CRC, colorectal cancer.
Figure 2
Figure 2
Outcomes of the completion surgery group. ESD, endoscopic submucosal dissection. R0, radical resection; Rx, unsure radicality; R1, non-radical.
See this image and copyright information in PMC

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