Long-Term Outcomes of Additional Surgery After Endoscopic Resection Versus Primary Surgery for T1 Colorectal Cancer-Reference-Cited by-同舟云学术

Long-Term Outcomes of Additional Surgery After Endoscopic Resection Versus Primary Surgery for T1 Colorectal Cancer

Published:2024-06-12 Issue: Volume: Page:
ISSN:0002-9270
Container-title:American Journal of Gastroenterology
language:en
Short-container-title:Am J Gastroenterol

Author:

Tamaru Yuzuru¹,Kuwai Toshio¹²^ORCID,Kajiwara Yoshiki³^ORCID,Oka Shiro⁴^ORCID,Saito Shoichi⁵,Fukunaga Yosuke⁶^ORCID,Kawachi Hiroshi⁷^ORCID,Takamatsu Manabu⁷^ORCID,Hotta Kinichi⁸^ORCID,Ikematsu Hiroaki⁹^ORCID,Kojima Motohiro¹⁰,Saito Yutaka¹¹^ORCID,Kanemitsu Yukihide¹²^ORCID,Yamada Masayoshi¹¹^ORCID,Sekine Shigeki¹³,Tanaka Shinji⁴^ORCID,Nagata Shinji¹⁴,Nakamura Takahiro¹⁵^ORCID,Yamada Kazutaka¹⁶,Konno Maki¹⁷,Ishihara Soichiro¹⁸,Saitoh Yusuke¹⁹,Matsuda Kenji²⁰,Togashi Kazutomo²¹^ORCID,Komori Koji²²^ORCID,Ishiguro Megumi²³^ORCID,Okuyama Takashi²⁴^ORCID,Ohuchi Akihiro²⁵,Ohnuma Shinobu²⁶^ORCID,Sakamoto Kazuhiro²⁷^ORCID,Sugai Tamotsu²⁸^ORCID,Katsumata Kenji²⁹^ORCID,Matsushita Hiro-o³⁰,Yamano Hiro-o³¹^ORCID,Nakai Keisuke³²^ORCID,Uraoka Toshio³³^ORCID,Akimoto Naohiko³⁴^ORCID,Kobayashi Hirotoshi³⁵^ORCID,Ajioka Yoichi³⁶,Sugihara Kenichi³⁷,Ueno Hideki³^ORCID

Affiliation:

1. Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan;

2. Gastrointestinal Endoscopy and Medicine, Hiroshima University Hospital, Hiroshima, Japan;

3. Department of Surgery, National Defense Medical College, Tokorozawa, Japan;

4. Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan;

5. Department of Lower Gastrointestinal Medicine, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan;

6. Department of Colorectal Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan;

7. Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan;

8. Division of Endoscopy, Shizuoka Cancer Center, Sunto, Japan;

9. Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan;

10. Division of Pathology, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Japan;

11. Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan;

12. Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan;

13. Pathology and Clinical Laboratory Division, National Cancer Center Hospital, Tokyo, Japan;

14. Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan;

15. Laboratory for Mathematics, National Defense Medical College, Tokorozawa, Japan ;

16. Coloproctology Center Takano Hospital, Kumamoto, Japan;

17. Department of Gastroenterology, Tochigi Cancer Center, Utsunomiya, Japan;

18. Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan;

19. Digestive Disease Center, Asahikawa City Hospital, Asahikawa, Japan;

20. Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan;

21. Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan;

22. Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan;

23. Medical Innovation Promotion Center, Tokyo Medical and Dental University, Tokyo, Japan;

24. Department of Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan;

25. Department of Gastroenterology, School of Medicine, Kurume University, Kurume, Japan;

26. Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan;

27. Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan;

28. Department of Molecular Diagnostic Pathology, School of Medicine, Iwate Medical University, Shiwa, Japan;

29. Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan;

30. Digestive Disease Center, Akita Red Cross Hospital, Akita, Japan;

31. Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan;

32. Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan;

33. Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan;

34. Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan;

35. Department of Surgery, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan;

36. Division of Molecular and Diagnostic Pathology, Graduate School of Medical and Dental Science, Niigata University, Niigata, Japan;

37. Tokyo Medical and Dental University, Tokyo, Japan.

Abstract

INTRODUCTION: There is considerable concern about whether endoscopic resection (ER) before additional surgery (AS) for T1 colorectal cancer (CRC) has oncologically potential adverse effects. Therefore, the aim of this study was to compare the long-term outcomes, including overall survival (OS), of patients treated with AS after ER vs primary surgery (PS) for T1 CRC using a propensity score-matched analysis from a large observational study. METHODS: This study investigated 6,105 patients with T1 CRC treated with either ER or surgical resection between 2009 and 2016 at 27 high-volume Japanese institutions, with those undergoing surgery alone included in the PS group and those undergoing AS after ER included in the AS group. Propensity score matching was used for long-term outcomes of mortality and recurrence analysis. RESULTS: After propensity score matching, 1,219 of 2,438 patients were identified in each group. The 5-year OS rates in the AS and PS groups were 97.1% and 96.0%, respectively (hazard ratio: 0.72, 95% confidence interval: 0.49–1.08), indicating the noninferiority of the AS group. Moreover, 32 patients (2.6%) in the AS group and 24 (2.0%) in the PS group had recurrences, with no significant difference between the 2 groups (odds ratio: 1.34, 95% confidence interval: 0.76–2.40, P = 0.344). DISCUSSION: ER before AS for T1 CRC had no adverse effect on patients' long-term outcomes, including the 5-year OS rate. ER is a viable first-line treatment option for endoscopically resectable T1 CRC.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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