Risks of Recurrence and Mortality After Local Endoscopic Resection of T1 Colorectal Cancer
Douglas K. Rex, MD, MASGE, reviewing Dang H, et al. Clin Gastroenterol Hepatol 2020 Nov 30.
In a meta-analysis of 71 studies involving 5167 endoscopically treated T1 colorectal cancers (CRCs), the cumulative recurrence rate was 3.3%, the local recurrence rate was 1.9%, and the distant recurrence rate was 1.6%. Among those with recurrence, the CRC-related mortality rate was 41%, and 96% of recurrences occurred within 72 months of follow-up.
An analysis of risk factors for recurrence suggested that the histology of the primary cancer was the only predictor. Among high-risk features (positive resection margin, deep submucosal invasion, poor differentiation, lymphovascular invasion, or high-grade tumor budding), the recurrence rate was 7% compared to 0.7% in cases of low histologic risk.
COMMENTThese results are valuable guides for comparing the risk of recurrence to the risk of surgery (based on age and comorbidities) for patients with endoscopically resected T1 cancer, according to the histologic assessment. Although intense surveillance for patients at high risk of recurrence has not been proven effective, results generally suggest that high-intensity surveillance by repeat endoscopy, carcinoembryonic antigen testing, and CT scanning may be an appropriate choice for some patients at high risk of recurrence, especially if surgical risk is high.
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)
Dang H, Dekkers N, le Cessie S, et al. Risk and time pattern of recurrences after local endoscopic resection of T1 colorectal cancer: a meta-analysis. Clin Gastroenterol Hepatol 2020 Nov 30. (Epub ahead of print ) (https://doi.org/10.1016/j.cgh.2020.11.032)
