- 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.
- 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.
- 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.
- Histopathological risk factors were not consistently reported.