Background & Aims

There is controversy over the best therapeutic approach for T1 colorectal cancer. We performed a systematic review and meta-analysis of long-term outcomes of endoscopic resection (ER) vs those of primary or additional surgery.

Methods

We performed a systematic review of the PubMed, Embase, and Cochrane databases through October 2019 for studies that reported outcomes (overall survival, disease-specific survival, recurrence-free survival at 5 years, recurrence, and metastasis) of ER vs surgery in patients with colorectal neoplasms. Hazard ratios (HR) were calculated based on time to events.

Results

In total, 17 published studies with 19,979 patients were included. The median follow-up time among the studies was 36 months. The meta-analysis found no significant differences between primary ER and primary surgery in overall survival (79.6% vs 82.1%, HR, 1.10; 95% CI, 0.84–1.45), recurrence-free survival (96.0% vs 96.7%, HR, 1.28; 95% CI, 0.87–1.88), or disease-specific survival (94.8% vs 96.5%; HR, 1.09; 95% CI, 0.67–1.78). Additional surgery and primary surgery did not produce significant differences in recurrence-free survival (HR, 1.27; 95% CI, 0.85–1.89). A significantly lower proportion of patients who underwent primary ER had procedure-related adverse events (2.3%) than patients who underwent primary surgery (10.9%) (P < .001). Lymphovascular invasion and rectal cancer, but not depth of submucosal invasion, were independently associated with recurrence for all T1 colorectal cancers.

Conclusions

In a systematic review and meta-analysis, we found that ER should be considered as the first-line treatment for endoscopically resectable T1 colorectal cancers. In cases of noncurative resection, additional surgery can have comparable outcomes to primary surgery.

中文翻译：

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T1 期结直肠癌初次内镜切除术与手术的长期结果：系统评价和荟萃分析。

背景与目标

对于 T1 期结直肠癌的最佳治疗方法存在争议。我们对内镜切除术 (ER) 与初次或附加手术的长期结果进行了系统回顾和荟萃分析。

方法

我们对截至 2019 年 10 月的 PubMed、Embase 和 Cochrane 数据库进行了系统评价，这些数据库报告了患者 ER 与手术的结果（总生存期、疾病特异性生存期、5 年无复发生存期、复发和转移）结直肠肿瘤。基于事件发生时间计算危险比 (HR)。

结果

总共纳入了 17 项已发表的研究，涉及 19,979 名患者。这些研究的中位随访时间为 36 个月。荟萃分析发现原发 ER 和原发手术在总生存率（79.6% 与 82.1%，HR，1.10；95% CI，0.84-1.45）、无复发生存率（96.0% 与 96.7%，HR， 1.28；95% CI，0.87–1.88），或疾病特异性生存率（94.8% vs 96.5%；HR，1.09；95% CI，0.67–1.78）。额外手术和初次手术在无复发生存率方面没有显着差异（HR，1.27；95% CI，0.85-1.89）。与接受初次手术的患者 (10.9%) 相比，接受初次 ER 的患者出现手术相关不良事件的比例 (2.3%) 显着降低 (P < .001)。淋巴血管浸润和直肠癌，但不是粘膜下浸润深度，

结论

在系统评价和荟萃分析中，我们发现 ER 应被视为可内镜下可切除的 T1 期结直肠癌的一线治疗。在非治愈性切除的情况下，额外手术的结果与初次手术相当。