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Long-term outcomes of endoscopic or surgical resection in T1 colorectal cancer patients: a retrospective cohort study

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Abstract

Background

The personalized treatments of T1 colorectal cancer (CRC) remains controversial. We compared the long-term outcomes of T1 CRC patients after endoscopic resection (ER) and surgery, and evaluated the risk factors for the long-term prognosis.

Methods

T1 CRCs after resection at the Cancer Hospital, Chines Academy of Medical Sciences from June 2011 to November 2021 were reviewed. High-risk factors included positive resection margin, poor differentiation, deep submucosal invasion (DSI ≥ 1000 μm), lymphovascular invasion and intermediate/high tumor budding. Comparative analyses were conducted based on three treatment methods: follow-up after ER (Group A), additional surgery after ER (Group B) and initial surgery (Group C). The primary endpoints included recurrence-free survival (RFS) and overall survival (OS). Cox proportional hazard regression models were constructed to identify risk factors for RFS and OS.

Results

A total of 528 patients were enrolled (173 patients in Group A, 102 patients in Group B, 253 patients in Group C). The 3-year RFS, 5-year RFS, 3-year OS, and 5-year OS rates were 96.7%, 94.7%, 99.1%, and 97.8%, respectively. In the absence of other high-risk factors, RFS (P = 0.321) and OS (P = 0.155) of patients with DSI after ER were not inferior to those after surgery. Multivariate analyses identified sex (HR 0.379; 95% CI 0.160–0.894), Charlson comorbidities index (CCI) (HR 3.330; 95% CI 1.571–7.062), margin (HR 8.212; 95% CI 2.325–29.006), and budding (HR 3.794; 95% CI 1.686–8.541) as independent predictive factors of RFS, and identified CCI (HR 10.266; 95% CI 2.856–36.899) as an independent predictive factor of OS.

Conclusion

The long-term outcomes of ER are comparable to those of surgery in T1 CRC patients with DSI when other high-risk factors are negative. Resection margin, tumor budding, sex, and CCI may be the most important long-term prognostic factors for T1 CRC patients.

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Acknowledgements

We are very grateful to all patients and families that agreed to participate in the study.

Funding

This research was supported by grants from (1) CAMS Innovation Fund for Medical Sciences (CIFMS) (Grant Nos. 2021-I2M-1-061, 2021-I2M-1-015, 2021-I2M-1-013, 2022-I2M-C&T-B-054, 2021-I2M-1-010); (2) Sanming Project of Medicine in Shenzhen (No. SZSM201911008); (3) Capital’s Funds for Health Improvement and Research (Grant No. CRF2020-2-4025); (4) Beijing Hope Run Special Fund of Cancer Foundation of China (Grant No. LC2021A03).

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Authors and Affiliations

  1. Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuannanli, Chaoyang District, Beijing, 100021, China

    Shibo Song, Lizhou Dou, Yueming Zhang, Xudong Liu, Yong Liu, Shun He & Guiqi Wang

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  1. Shibo Song
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Correspondence to Shun He or Guiqi Wang.

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Shibo Song, Lizhou Dou, Yueming Zhang, Xudong Liu, Yong Liu, Shun He, and Guiqi Wang have no conflicts of interest or financial ties to disclose.

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Song, S., Dou, L., Zhang, Y. et al. Long-term outcomes of endoscopic or surgical resection in T1 colorectal cancer patients: a retrospective cohort study. Surg Endosc 38, 1499–1511 (2024). https://doi.org/10.1007/s00464-023-10586-w

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