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Gut. 2018 Feb;67(2):284-290. doi: 10.1136/gutjnl-2015-310961. Epub 2016 Nov 3.

Endoscopic resection of high-risk T1 colorectal carcinoma prior to surgical resection has no adverse effect on long-term outcomes.

Author information

1
Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
2
Department of Gastroenterology & Hepatology, Flevohospital, Almere, The Netherlands.
3
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
4
Department of Gastroenterology & Hepatology, Rijnstate, Arnhem, The Netherlands.
5
Department of Gastroenterology & Hepatology, Amphia Hospital, Breda, The Netherlands.
6
Department of Gastroenterology & Hepatology, Meander Medical Center, Amersfoort, The Netherlands.
7
Department of Gastroenterology & Hepatology, Isala, Zwolle, The Netherlands.
8
Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.
9
Department of Gastroenterology & Hepatology, Gelderse Vallei, Ede, The Netherlands.
10
Department of Gastroenterology & Hepatology, Groene Hart Hospital, Gouda, The Netherlands.
11
Department of Gastroenterology & Hepatology, Diakonessenhuis Utrecht, Utrecht, The Netherlands.
12
Department of Gastroenterology & Hepatology, St. Jansdal Harderwijk, Harderwijk, The Netherlands.
13
Department of Gastroenterology & Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands.
14
Department of Gastroenterology & Hepatology, Deventer Hospital, Deventer, The Netherlands.
15
Department of Gastroenterology & Hepatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.

Abstract

OBJECTIVE:

It is difficult to predict the presence of histological risk factors for lymph node metastasis (LNM) before endoscopic treatment of T1 colorectal cancer (CRC). Therefore, endoscopic therapy is propagated to obtain adequate histological staging. We examined whether secondary surgery following endoscopic resection of high-risk T1 CRC does not have a negative effect on patients' outcomes compared with primary surgery.

DESIGN:

Patients with T1 CRC with one or more histological risk factors for LNM (high risk) and treated with primary or secondary surgery between 2000 and 2014 in 13 hospitals were identified in the Netherlands Cancer Registry. Additional data were collected from hospital records, endoscopy, radiology and pathology reports. A propensity score analysis was performed using inverse probability weighting (IPW) to correct for confounding by indication.

RESULTS:

602 patients were eligible for analysis (263 primary; 339 secondary surgery). Overall, 34 recurrences were observed (5.6%). After adjusting with IPW, no differences were observed between primary and secondary surgery for the presence of LNM (OR 0.97; 95% CI 0.49 to 1.93; p=0.940) and recurrence during follow-up (HR 0.97; 95% CI 0.41 to 2.34; p=0.954). Further adjusting for lymphovascular invasion, depth of invasion and number of retrieved lymph nodes did not alter this outcome.

CONCLUSIONS:

Our data do not support an increased risk of LNM or recurrence after secondary surgery compared with primary surgery. Therefore, an attempt for an en-bloc resection of a possible T1 CRC without evident signs of deep invasion seems justified in order to prevent surgery of low-risk T1 CRC in a significant proportion of patients.

KEYWORDS:

COLONIC POLYPS; COLONOSCOPY; COLORECTAL CARCINOMA; COLORECTAL SURGERY; THERAPEUTIC ENDOSCOPY

PMID:
27811313
DOI:
10.1136/gutjnl-2015-310961
[Indexed for MEDLINE]

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