Additional surgery bests surveillance only after endoscopic resection in early colorectal cancer patients: Study
Researchers have recently discovered that additional surgery post-non-curative endoscopic resection (ER) for early colorectal cancer (CRC) patients resulted in significantly better clinical outcomes compared with surveillance alone. A recent study was published in the journal BMC Gastroenterology conducted by Chung-Zeng Jia.
For patients with early colorectal cancer treated non-curatively with ER, management decisions after the procedure are problematic. Surveillance-only strategies can spare these patients additional intervention, but they also leave the patient susceptible to recurrence and poor long-term outcomes. This debate therefore warranted a systematic review and meta-analysis to compare additional surgery versus surveillance-only management strategies for this population of patients.
A comprehensive literature search on PubMed, Embase, and the Cochrane Library retrieved 15 high-quality studies that included 3,508 patients, 1,974 in the additional surgery group, and 1,533 in the surveillance-only group. The Newcastle-Ottawa Quality Scale was used to evaluate the methodological quality of the studies, and all of them had a score of at least 6. Statistical analyses were done using STATA software by pooling and subgroup evaluations. Subgroup analyses were conducted to assess the differences in outcomes by age and inclusion frameworks.
Key findings:
Survival Outcomes Post Additional Surgery
• The presence of additional surgery resulted in more patients having improved overall survival (OR = 2.95, 95% CI: 2.05–4.24, P < 0.05) and recurrence-free survival (OR = 2.53, 95% CI: 1.38–4.62, P < 0.05).
Decreased Risk of Relapse
• The group having undergone additional surgery had lesser rates of overall relapse (OR = 1.96, 95% CI: 1.22–3.13, P < 0.05) and rate of local relapse (OR = 2.35, 95% CI: 1.12–4.95, P < 0.05).
Further insights by subgroup
• Subgroup analyses based on inclusion criteria showed differences in outcomes (JSCCR subgroup: OR = 2.09; 95% CI: 1.32–3.30 vs. non-JSCCR subgroup: OR = 1.54; 95% CI: 0.89–2.65).
• No significant differences in recurrence rates were found between age groups that used 65 years as the cutoff.
In conclusion, additional surgery will bring many advantages compared with surveillance-alone strategies in patients with early CRC who have been treated with non-curative ER. Such evidence may help guide clinical decisions in this complex clinical scenario and indicate the potential for surgical intervention to improve patient outcomes.
Reference:
Jia CZ. Long-term outcomes of additional surgery versus surveillance-only clinical decision for early colorectal cancer patients after non-curative endoscopic resection: a meta-analysis. BMC Gastroenterol. 2024 Nov 20;24(1):416. doi: 10.1186/s12876-024-03502-6. PMID: 39567887; PMCID: PMC11580549.
