Long-Term Outcomes of T1 Colorectal Cancer after Endoscopic Resection

• Main Authors: Eun Young Park, Dong Hoon Baek, Moon Won Lee, Gwang Ha Kim, Do Youn Park, Geun Am Song
• Format: Article
• Language: English
• Published: MDPI AG 2020-07-01
• Series: Journal of Clinical Medicine
• Subjects: colorectal cancer; endoscopic resection; overall survival; recurrence-free survival
• Online Access: https://www.mdpi.com/2077-0383/9/8/2451

Background and Aims: Endoscopic resection (ER) for submucosal invasive colorectal cancer (T1 CRC) can be grouped as curative ER (C-ER) and non-curative ER (NC-ER). Little is known about the long-term outcomes of patients in these two groups. Therefore, we have evaluated the long-term outcomes in endoscopically resected T1 CRC patients in C-ER and NC-ER groups. Methods: We conducted a retrospective study on 220 patients with T1 CRC treated with ER from January 2007 to December 2017. First, we investigated the long-term outcomes (5-year overall survival [OS] and recurrence-free survival [RFS]) in the C-ER group (<i>n</i> = 49). In the NC-ER group (<i>n</i> = 171), we compared long-term outcomes between patients who underwent additional surgical resection (ASR) (<i>n</i> = 117) and those who did not (surveillance-only, <i>n</i> = 54). Results: T1 CRC patients in the C-ER and NC-ER groups had a median follow-up of 44 (interquartile range 32–69) months. There was no risk of tumor recurrence and cancer-related deaths in patients with C-ER. In the NC-ER group, the 5-year OS rates were 75.3% and 92.6% in the surveillance-only and ASR subgroups, respectively. The hazard ratio (HR) for ASR in NC-ER vs. surveillance-only in NC-ER was statistically insignificant. However, RFS rates were significantly different between the ASR (97.2%) and surveillance-only (84.0%) subgroups. Multivariate analysis indicated a submucosal invasion depth (SID) of >2500 µm and margin positivity to be associated with recurrence. Conclusions: The surveillance-only approach can be considered as an alternative surgical option for T1 CRCs in selected patients undergoing NC-ER.