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

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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.

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Authors and Affiliations

  1. Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Hyun Jin Bae

  2. Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea

    Hoyeon Ju, Bo-In Lee & Young-Seok Cho

  3. Department of Internal Medicine, Yeoido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Han Hee Lee

  4. Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Jinsu Kim

  5. Department of Hospital Pathology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Sung Hak Lee

  6. Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Daeyoun David Won, Yoon Suk Lee & In Kyu Lee

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  1. Hyun Jin Bae
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Correspondence to Young-Seok Cho.

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Drs. Hyun Jin Bae, Hoyeon Ju, Han Hee Lee, Jinsu Kim, Bo-In Lee, Sung Hak Lee, Daeyoun David Won, Yoon Suk Lee, In Kyu Lee, and Young-Seok Cho have no conflict of interest or financial ties to disclose.

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Bae, H.J., Ju, H., Lee, H.H. et al. Long-term outcomes after endoscopic versus surgical resection of T1 colorectal carcinoma. Surg Endosc 37, 1231–1241 (2023). https://doi.org/10.1007/s00464-022-09649-1

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