Yu Liu1,2, Ran Li3, Wenju Chang1,2,4, Li Ren1,2,4, Ye Wei1,2,4, Tianyu Liu1,2, Yijiao Chen1,2, Minzhi Lv5, Yunshi Zhong6,7,8,9, Jianmin Xu10,11,12. 1. Colorectal Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China. 2. Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China. 3. Endoscopic Center, Zhongshan Hospital, Fudan University, Shanghai, China. 4. Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive, Shanghai, China. 5. Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, China. 6. Colorectal Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China. 13564623481@126.com. 7. Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China. 13564623481@126.com. 8. Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive, Shanghai, China. 13564623481@126.com. 9. Endoscopic Center, Zhongshan Hospital, Fudan University, Shanghai, China. 13564623481@126.com. 10. Colorectal Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China. xujmin@aliyun.com. 11. Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China. xujmin@aliyun.com. 12. Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive, Shanghai, China. xujmin@aliyun.com.
Abstract
BACKGROUND AND AIM: Radical surgery is recommended for T1 colorectal cancer with non-curative endoscopic resection. However, there is still insufficient evidence about whether the non-curative endoscopic resection prior to surgical resection affects the short-term and long-term outcomes of patients. The purpose of this study was to investigate the effect of non-curative endoscopic resection before surgical resection on short-term and long-term outcomes in patients with T1 colorectal cancer. PATIENTS AND METHODS: Patients with clinical T1N0M0 (cT1N0M0) colorectal cancer who underwent direct surgery or additional radical surgery after non-curative endoscopic resection were collected. We evaluated postoperative complications and long-term prognosis between the two groups. RESULTS: From 2011 to 2017, 779 patients were clinically diagnosed with T1N0M0 colorectal cancer at Zhongshan Hospital. We assessed patients who underwent additional surgery following the prior non-curative endoscopic resection (n = 145) and patients who underwent radical surgery directly (n = 336). There was no significant difference in 5-year OS (99.3% vs. 99.4%, P = 0.866) and 5-year DFS (97.2% vs. 97.3%, P = 0.909) between the two groups. The total complication rate was slightly higher in prior endoscopic resection group (15.2% vs. 9.5%, P = 0.111). The 5-year OS and 5-year DFS of patients who refused additional surgery (n = 95) were significantly lower than ER prior to surgery group (For OS, 92.6% vs. 99.3%, P = 0.017; for DFS, 91.2% vs. 97.2%, P = 0.021). CONCLUSION: In patients who underwent additional surgery, non-curative endoscopic resection of cT1 colorectal carcinoma did not have adverse effect on short-term and long-term outcomes. Additional surgery should be recommended in patients who received non-curative ER.
BACKGROUND AND AIM: Radical surgery is recommended for T1 colorectal cancer with non-curative endoscopic resection. However, there is still insufficient evidence about whether the non-curative endoscopic resection prior to surgical resection affects the short-term and long-term outcomes of patients. The purpose of this study was to investigate the effect of non-curative endoscopic resection before surgical resection on short-term and long-term outcomes in patients with T1 colorectal cancer. PATIENTS AND METHODS: Patients with clinical T1N0M0 (cT1N0M0) colorectal cancer who underwent direct surgery or additional radical surgery after non-curative endoscopic resection were collected. We evaluated postoperative complications and long-term prognosis between the two groups. RESULTS: From 2011 to 2017, 779 patients were clinically diagnosed with T1N0M0 colorectal cancer at Zhongshan Hospital. We assessed patients who underwent additional surgery following the prior non-curative endoscopic resection (n = 145) and patients who underwent radical surgery directly (n = 336). There was no significant difference in 5-year OS (99.3% vs. 99.4%, P = 0.866) and 5-year DFS (97.2% vs. 97.3%, P = 0.909) between the two groups. The total complication rate was slightly higher in prior endoscopic resection group (15.2% vs. 9.5%, P = 0.111). The 5-year OS and 5-year DFS of patients who refused additional surgery (n = 95) were significantly lower than ER prior to surgery group (For OS, 92.6% vs. 99.3%, P = 0.017; for DFS, 91.2% vs. 97.2%, P = 0.021). CONCLUSION: In patients who underwent additional surgery, non-curative endoscopic resection of cT1colorectal carcinoma did not have adverse effect on short-term and long-term outcomes. Additional surgery should be recommended in patients who received non-curative ER.