Long-term outcomes after endoscopic versus surgical resection of T1 colorectal carcinoma
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 T...
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| Veröffentlicht in: | Surgical endoscopy 2023-02, Vol.37 (2), p.1231-1241 |
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| creator | Bae, Hyun Jin Ju, Hoyeon Lee, Han Hee Kim, Jinsu Lee, Bo-In Lee, Sung Hak Won, Daeyoun David Lee, Yoon Suk Lee, In Kyu Cho, Young-Seok |
| description | 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
|
| doi_str_mv | 10.1007/s00464-022-09649-1 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2719420702</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2778479420</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-fcd3a0d5f268a92154907b27c784363403b9018e8a7dd10acf7e5093927caac43</originalsourceid><addsrcrecordid>eNp9kE1LxDAQhoMo7rr6BzxIwIuX6OSjTXOUxS9Y8LKCt5BN06VL26xJK_jvzdpVwYOnkMwz70wehM4pXFMAeRMBRC4IMEZA5UIReoCmVHBGGKPFIZqC4kCYVGKCTmLcQOIVzY7RhOdUUpHxKXpd-G5Nehda7Ife-tZFbKp0x64rfbR-W1v87kIcIo5DWNfWNDi46Gxf-w77Ci8ptr7xIb2kkjXB1p1vzSk6qkwT3dn-nKGX-7vl_JEsnh-e5rcLYrnMelLZkhsos4rlhVGMZkKBXDFpZSF4zgXwlQJauMLIsqRgbCVdlv6lEmKMFXyGrsbcbfBvg4u9butoXdOYzvkhaiapEgwksIRe_kE3fghd2i5RaZ7cgYliI2WDjzG4Sm9D3ZrwoSnonXc9etfJu_7yrmlquthHD6vWlT8t36ITwEcgplK3duF39j-xn2ZUjSg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2778479420</pqid></control><display><type>article</type><title>Long-term outcomes after endoscopic versus surgical resection of T1 colorectal carcinoma</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Bae, Hyun Jin ; Ju, Hoyeon ; Lee, Han Hee ; Kim, Jinsu ; Lee, Bo-In ; Lee, Sung Hak ; Won, Daeyoun David ; Lee, Yoon Suk ; Lee, In Kyu ; Cho, Young-Seok</creator><creatorcontrib>Bae, Hyun Jin ; Ju, Hoyeon ; Lee, Han Hee ; Kim, Jinsu ; Lee, Bo-In ; Lee, Sung Hak ; Won, Daeyoun David ; Lee, Yoon Suk ; Lee, In Kyu ; Cho, Young-Seok</creatorcontrib><description>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.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-022-09649-1</identifier><identifier>PMID: 36171453</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal Surgery ; Colorectal cancer ; Colorectal Neoplasms - surgery ; Decision making ; Endoscopy ; Gastroenterology ; Gynecology ; Hepatology ; Hospitals ; Humans ; Internal medicine ; Lymphatic Metastasis ; Lymphatic system ; Medical prognosis ; Medical schools ; Medical screening ; Medicine ; Medicine & Public Health ; Metastasis ; Mortality ; Neoplasm Recurrence, Local - pathology ; Original Article ; Pathology ; Patients ; Proctology ; Prognosis ; Retrospective Studies ; Risk Factors ; Surgery</subject><ispartof>Surgical endoscopy, 2023-02, Vol.37 (2), p.1231-1241</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022. Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-fcd3a0d5f268a92154907b27c784363403b9018e8a7dd10acf7e5093927caac43</citedby><cites>FETCH-LOGICAL-c375t-fcd3a0d5f268a92154907b27c784363403b9018e8a7dd10acf7e5093927caac43</cites><orcidid>0000-0003-1537-3427</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-022-09649-1$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-022-09649-1$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36171453$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bae, Hyun Jin</creatorcontrib><creatorcontrib>Ju, Hoyeon</creatorcontrib><creatorcontrib>Lee, Han Hee</creatorcontrib><creatorcontrib>Kim, Jinsu</creatorcontrib><creatorcontrib>Lee, Bo-In</creatorcontrib><creatorcontrib>Lee, Sung Hak</creatorcontrib><creatorcontrib>Won, Daeyoun David</creatorcontrib><creatorcontrib>Lee, Yoon Suk</creatorcontrib><creatorcontrib>Lee, In Kyu</creatorcontrib><creatorcontrib>Cho, Young-Seok</creatorcontrib><title>Long-term outcomes after endoscopic versus surgical resection of T1 colorectal carcinoma</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>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.</description><subject>Abdominal Surgery</subject><subject>Colorectal cancer</subject><subject>Colorectal Neoplasms - surgery</subject><subject>Decision making</subject><subject>Endoscopy</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Internal medicine</subject><subject>Lymphatic Metastasis</subject><subject>Lymphatic system</subject><subject>Medical prognosis</subject><subject>Medical schools</subject><subject>Medical screening</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metastasis</subject><subject>Mortality</subject><subject>Neoplasm Recurrence, Local - pathology</subject><subject>Original Article</subject><subject>Pathology</subject><subject>Patients</subject><subject>Proctology</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Surgery</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kE1LxDAQhoMo7rr6BzxIwIuX6OSjTXOUxS9Y8LKCt5BN06VL26xJK_jvzdpVwYOnkMwz70wehM4pXFMAeRMBRC4IMEZA5UIReoCmVHBGGKPFIZqC4kCYVGKCTmLcQOIVzY7RhOdUUpHxKXpd-G5Nehda7Ife-tZFbKp0x64rfbR-W1v87kIcIo5DWNfWNDi46Gxf-w77Ci8ptr7xIb2kkjXB1p1vzSk6qkwT3dn-nKGX-7vl_JEsnh-e5rcLYrnMelLZkhsos4rlhVGMZkKBXDFpZSF4zgXwlQJauMLIsqRgbCVdlv6lEmKMFXyGrsbcbfBvg4u9butoXdOYzvkhaiapEgwksIRe_kE3fghd2i5RaZ7cgYliI2WDjzG4Sm9D3ZrwoSnonXc9etfJu_7yrmlquthHD6vWlT8t36ITwEcgplK3duF39j-xn2ZUjSg</recordid><startdate>20230201</startdate><enddate>20230201</enddate><creator>Bae, Hyun Jin</creator><creator>Ju, Hoyeon</creator><creator>Lee, Han Hee</creator><creator>Kim, Jinsu</creator><creator>Lee, Bo-In</creator><creator>Lee, Sung Hak</creator><creator>Won, Daeyoun David</creator><creator>Lee, Yoon Suk</creator><creator>Lee, In Kyu</creator><creator>Cho, Young-Seok</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1537-3427</orcidid></search><sort><creationdate>20230201</creationdate><title>Long-term outcomes after endoscopic versus surgical resection of T1 colorectal carcinoma</title><author>Bae, Hyun Jin ; Ju, Hoyeon ; Lee, Han Hee ; Kim, Jinsu ; Lee, Bo-In ; Lee, Sung Hak ; Won, Daeyoun David ; Lee, Yoon Suk ; Lee, In Kyu ; Cho, Young-Seok</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-fcd3a0d5f268a92154907b27c784363403b9018e8a7dd10acf7e5093927caac43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Abdominal Surgery</topic><topic>Colorectal cancer</topic><topic>Colorectal Neoplasms - surgery</topic><topic>Decision making</topic><topic>Endoscopy</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Internal medicine</topic><topic>Lymphatic Metastasis</topic><topic>Lymphatic system</topic><topic>Medical prognosis</topic><topic>Medical schools</topic><topic>Medical screening</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metastasis</topic><topic>Mortality</topic><topic>Neoplasm Recurrence, Local - pathology</topic><topic>Original Article</topic><topic>Pathology</topic><topic>Patients</topic><topic>Proctology</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bae, Hyun Jin</creatorcontrib><creatorcontrib>Ju, Hoyeon</creatorcontrib><creatorcontrib>Lee, Han Hee</creatorcontrib><creatorcontrib>Kim, Jinsu</creatorcontrib><creatorcontrib>Lee, Bo-In</creatorcontrib><creatorcontrib>Lee, Sung Hak</creatorcontrib><creatorcontrib>Won, Daeyoun David</creatorcontrib><creatorcontrib>Lee, Yoon Suk</creatorcontrib><creatorcontrib>Lee, In Kyu</creatorcontrib><creatorcontrib>Cho, Young-Seok</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bae, Hyun Jin</au><au>Ju, Hoyeon</au><au>Lee, Han Hee</au><au>Kim, Jinsu</au><au>Lee, Bo-In</au><au>Lee, Sung Hak</au><au>Won, Daeyoun David</au><au>Lee, Yoon Suk</au><au>Lee, In Kyu</au><au>Cho, Young-Seok</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long-term outcomes after endoscopic versus surgical resection of T1 colorectal carcinoma</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2023-02-01</date><risdate>2023</risdate><volume>37</volume><issue>2</issue><spage>1231</spage><epage>1241</epage><pages>1231-1241</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><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.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>36171453</pmid><doi>10.1007/s00464-022-09649-1</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0003-1537-3427</orcidid></addata></record> |
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| source | MEDLINE; SpringerLink Journals |
| subjects | Abdominal Surgery Colorectal cancer Colorectal Neoplasms - surgery Decision making Endoscopy Gastroenterology Gynecology Hepatology Hospitals Humans Internal medicine Lymphatic Metastasis Lymphatic system Medical prognosis Medical schools Medical screening Medicine Medicine & Public Health Metastasis Mortality Neoplasm Recurrence, Local - pathology Original Article Pathology Patients Proctology Prognosis Retrospective Studies Risk Factors Surgery |
| title | Long-term outcomes after endoscopic versus surgical resection of T1 colorectal carcinoma |
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