Format

Send to

Choose Destination
Am J Gastroenterol. 2017 May;112(5):785-796. doi: 10.1038/ajg.2017.58. Epub 2017 Mar 21.

Risk for Incomplete Resection after Macroscopic Radical Endoscopic Resection of T1 Colorectal Cancer: A Multicenter Cohort Study.

Author information

1
Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands.
2
Department of Gastroenterology and Hepatology, Isala, Zwolle, The Netherlands.
3
Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands.
4
Department of Gastroenterology and Hepatology, Deventer Hospital, Deventer, The Netherlands.
5
Department of Gastroenterology and Hepatology, Meander Medical Centre, Amersfoort, The Netherlands.
6
Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands.
7
Department of Gastroenterology and Hepatology, Diakonessenhuis, Utrecht, The Netherlands.
8
Department of Gastroenterology and Hepatology, Flevo Hospital, Almere, The Netherlands.
9
Department of Gastroenterology and Hepatology, Groene Hart Hospital, Gouda, The Netherlands.
10
Department of Gastroenterology and Hepatology, Sint Jansdal Hospital, Harderwijk, The Netherlands.
11
Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
12
Department of Gastroenterology and Hepatology, Amphia Hospital, Breda, The Netherlands.
13
Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, The Netherlands.
14
Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands.
15
Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands.

Abstract

OBJECTIVES:

The decision to perform secondary surgery after endoscopic resection of T1 colorectal cancer (CRC) depends on the risk of lymph node metastasis and the risk of incomplete resection. We aimed to examine the incidence and risk factors for incomplete endoscopic resection of T1 CRC after a macroscopic radical endoscopic resection.

METHODS:

Data from patients treated between 2000 and 2014 with macroscopic complete endoscopic resection of T1 CRC were collected from 13 hospitals. Incomplete resection was defined as local recurrence at the polypectomy site during follow-up or malignant tissue in the surgically resected specimen in case secondary surgery was performed. Multivariate regression analysis was performed to analyze factors associated with incomplete resection.

RESULTS:

In total, 877 patients with a median follow-up time of 36.5 months (interquartile range 16.0-68.3) were included, in whom secondary surgery was performed in 358 patients (40.8%). Incomplete resection was observed in 30 patients (3.4%; 95% confidence interval (CI) 2.3-4.6%). Incomplete resection rate was 0.7% (95% CI 0-2.1%) in low-risk T1 CRC vs. 4.4% (95% CI 2.7-6.5%) in high-risk T1 CRC (P=0.04). Overall adverse outcome rate (incomplete resection or metastasis) was 2.1% (95% CI 0-5.0%) in low-risk T1 CRC vs. 11.7% (95% CI 8.8-14.6%) in high-risk T1 CRC (P=0.001). Piecemeal resection (adjusted odds ratio 2.60; 95% CI 1.20-5.61, P=0.02) and non-pedunculated morphology (adjusted odds ratio 2.18; 95% CI 1.01-4.70, P=0.05) were independent risk factors for incomplete resection. Among patients in whom no additional surgery was performed, who developed recurrent cancer, 41.7% (95% CI 20.8-62.5%) died as a result of recurrent cancer.

CONCLUSIONS:

In the absence of histological high-risk factors, a 'wait-and-see' policy with limited follow-up is justified. Piecemeal resection and non-pedunculated morphology are independent risk factors for incomplete endoscopic resection of T1 CRC.

PMID:
28323275
DOI:
10.1038/ajg.2017.58
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Wolters Kluwer
Loading ...
Support Center