Endoscopic resection bests surgery for colorectal cancer, finds study

Recent research analyzed that endoscopic resection should be considered as the first-line treatment for endoscopically resectable T1 colorectal cancers. The study was published in the journal, "Clinical Gastroenterology and Hepatology" 2020.

With the developing advances in treatment procedures, many T1 colorectal cancers are resected endoscopically with negative margins. Additional surgery with lymph node dissection is considered if lymph node metastasis is suspected. But there is always controversy over the outcomes and the best therapeutic approach for T1 colorectal cancer.

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Researchers from E-DA Hospital/I-Shou University, Kaohsiung, Taiwan carried out a systematic review and meta-analysis of all the literature to assess the long-term outcomes (overall survival, disease-specific survival, recurrence-free survival at 5 years, recurrence, and metastasis) of endoscopic resection (ER) with those of primary or additional surgery. They collected data from PubMed, Embase, Cochrane databases through October 2019.

The key findings of the analysis were:

• In total, 17 published studies with 19,979 patients were included.

• The median follow-up time among the studies was 36 months.

• The meta-analysis found no significant differences between primary Endoscopic Resection and primary surgery in overall survival, recurrence-free survival, or disease-specific survival.

• Additional surgery and primary surgery did not produce significant differences in recurrence-free survival.

• A significantly lower proportion of patients who underwent primary Endoscopic resection had procedure-related adverse events (2.3%) than patients who underwent primary surgery (10.9%) (P < .001).

• Lymphovascular invasion and rectal cancer, but not the depth of submucosal invasion, were independently associated with recurrence for all T1 colorectal cancers.

Thus, the authors concluded that Endoscopic Resection should be considered as the first-line treatment for endoscopically resectable T1 colorectal cancers. They further added that in cases of non-curative resection, additional surgery can have comparable outcomes to primary surgery.

The study "Long-term Outcomes of Primary Endoscopic Resection vs Surgery for T1 Colorectal Cancer: A Systematic Review and Meta-analysis" was published in the Journal "Clinical Gastroenterology and Hepatology".

For further reading, click the following link: https://doi.org/10.1016/j.cgh.2020.05.060