pT1 colorectal cancer: is surgery needed after endoscopic resection?

  • Gastrointest Endosc

  • curated by Emily Willingham, PhD
  • Univadis Clinical Summaries
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Takeaway

  • Conservative management after endoscopic resection of submucosally invasive colorectal cancer (pT1-CRC) seems reasonable with low-risk lesions and possibly in specific high-risk cases.
  • With high-risk lesions, recurrence is about 10% and disease-specific mortality

Why this matters

  • The best approach to management after endoscopic resection of pT1-CRCs remains debated.
  • Endoscopy is an increasingly common approach globally.

Key results

  • Recurrence and cancer-specific mortality (CSM) with high-risk lesions (pooled cumulative values; 95% CIs):
    • 9.5% (6.7%-13.3%; I2=38.4%), and
    • 3.8% (2.4%-5.8%; I2=0%), respectively.
  • Recurrence and CSM with low-risk lesions (pooled, cumulative):
    • 1.2% (0.6%-2.5%; I2=0%), and 
    • 0.6% (0.2%-1.7%; I2=0%), respectively.
  • Pooled incidence rates of recurrence, CSM among high-risk patients:
    • 11 (2-20; I2=43.3%), and 
    • 4 (1-7; I2=0%) per 1000 patient-years, respectively.
  • And among low-risk patients:
    • 3 (95% CI, 0-6; I2=0%), and 
    • 2 (95% CI, 0-4; I2=0%) per 1000 patient-years, respectively.
  • Little publication heterogeneity identified.

Study design

  • Meta-analysis of 8 studies involving patients with pT1-CRC, low (n=650) or high (n=571) risk, who underwent endoscopic resection with no accompanying surgery, with ≥12 months follow-up.
  • Funding: None disclosed.

Limitations

  • Histopathological risk factors were not consistently reported.

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