New Study Suggests T2 Colorectal Cancers Could Be Resected Endoscopically and Analyzed for Risk of Lymph Node Metastases Before Surgical Resection
Douglas K. Rex, MD, MASGE, reviewing Ichimasa K, et al. Gastrointest Endosc 2022 Apr 29.
T2 colorectal cancers (CRCs) are almost invariably treated by surgical resection, but only 25% have lymph node metastases (LNM). An alternative approach in selected cases could be to remove them with the full-thickness resection device, and if the risk of LNM could be predicted as very low, adjuvant surgery might not be warranted.
This study analyzed 511 consecutive patients with surgical resection of T2 CRC between 2001 and 2016. Four hundred eleven patients were included in the training set for the artificial intelligence (AI) prediction tool and 100 in the validation group.
The 8 clinical or pathologic features included in the AI algorithm were age, sex, tumor size, tumor location, lymphatic invasion, vascular invasion, tumor differentiation, and serum carcinoembryonic antigen level.
LNM were present in 26% and 28% of the training and validation sets, respectively. With sensitivity and specificity of 96% and 88%, respectively, set in the algorithm, 64% of patients with T2 CRC could avoid surgery and 1.6% with LNM would not undergo surgery.
COMMENTThis would be an interesting approach, though we don’t know the fraction of T2 cancers that can be successfully resected with current devices for endoscopic full-thickness resection. The approach might be appropriate now for select cases in poor surgical candidates.
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)
Ichimasa K, Nakahara K, Kudo SE, et al. Novel “resect and analysis” approach for T2 colorectal cancer with use of artificial intelligence. Gastrointest Endosc 2022 Apr 29. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2022.04.1305)
