Does Endoscopic Resection of High-Risk T1 Colorectal Cancer Cause Adverse Oncologic Outcomes?
Douglas K. Rex, MD, MASGE, reviewing Takamaru H, et al. Clin Transl Gastroenterol 2021 Apr 12.
High-risk T1 colorectal cancer means there are adverse histologic features associated with an increased risk of lymph node metastases (LNM). The features are typically deep submucosal invasion (>1000 µ of submucosal invasion), lymphovascular invasion, etc. Frequently, the presence of high-risk cancer is not recognized until after the endoscopic resection. Some studies have suggested that endoscopic resection, itself, may adversely affect the risk of recurrence after adjuvant surgical therapy.
This study compared the recurrence rates in 162 patients with high-risk T1 cancer resected endoscopically and followed by adjuvant surgery and 392 patients with high-risk T1 cancer who underwent primary surgical resection. The recurrence rate was 2.5% in the endoscopic resection group and 3.3% in the primary surgery group. The mean number of dissected lymph nodes in the 2 groups was 24 and 25, respectively. There was also no difference in the ultimate recurrence rates in those who had positive LNM at the surgical resection and those who underwent adjuvant chemotherapy.
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COMMENTThese data support the notion that endoscopists resecting an unexpected high-risk T1 lesion do not need to worry about whether the resection causes adverse oncologic outcomes.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Takamaru H, Saito Y, Sekiguchi M, et al. Endoscopic resection before surgery does not affect the recurrence rate in patients with high-risk T1 colorectal cancer. Clin Transl Gastroenterol 2021;12:e00336. (https://doi.org/10.14309/ctg.0000000000000336)