Risk for Incomplete Resection after Macroscopic Radical Endoscopic Resection of T1 Colorectal Cancer: A Multicenter Cohort Study
| Autor: | W. H. de Vos tot Nederveen Cappel, Tom C.J. Seerden, Leon M G Moons, Joost M J Geesing, Peter D. Siersema, Bernhard W M Spanier, G. J. A. Offerhaus, Miangela M Lacle, Koen Kessels, Yara Backes, J van Bergeijk, Matthijs P. Schwartz, John N. Groen, M Kerkhof, Frank H J Wolfhagen, F. ter Borg, N. van Lelyveld |
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| Rok vydání: | 2016 |
| Předmět: |
Male
Reoperation medicine.medical_specialty Neoplasm Residual Colorectal cancer medicine.medical_treatment Colonoscopy Adenocarcinoma 03 medical and health sciences Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] 0302 clinical medicine Risk Factors medicine Journal Article Humans Watchful Waiting Survival rate Colectomy Aged Neoplasm Staging Retrospective Studies Hepatology medicine.diagnostic_test business.industry Gastroenterology Retrospective cohort study Middle Aged medicine.disease Surgery Multicenter Study Survival Rate Editorial 030220 oncology & carcinogenesis Lymphatic Metastasis 030211 gastroenterology & hepatology Female Neoplasm Recurrence Local business Colorectal Neoplasms Watchful waiting Cohort study Follow-Up Studies |
| Zdroj: | American Journal of Gastroenterology, 112, 785-796 American Journal of Gastroenterology, 112, 5, pp. 785-796 American Journal of Gastroenterology, 112, 785–796. Nature Publishing Group |
| ISSN: | 1572-0241 0002-9270 |
| Popis: | OBJECTIVES: The decision to perform secondary surgery after endoscopic resection of T1 colorectal cancer (CRC) depends on the risk of lymph node metastasis and the risk of incomplete resection. We aimed to examine the incidence and risk factors for incomplete endoscopic resection of T1 CRC after a macroscopic radical endoscopic resection. METHODS: Data from patients treated between 2000 and 2014 with macroscopic complete endoscopic resection of T1 CRC were collected from 13 hospitals. Incomplete resection was defined as local recurrence at the polypectomy site during follow-up or malignant tissue in the surgically resected specimen in case secondary surgery was performed. Multivariate regression analysis was performed to analyze factors associated with incomplete resection. RESULTS: In total, 877 patients with a median follow-up time of 36.5 months (interquartile range 16.0-68.3) were included, in whom secondary surgery was performed in 358 patients (40.8%). Incomplete resection was observed in 30 patients (3.4%; 95% confidence interval (CI) 2.3-4.6%). Incomplete resection rate was 0.7% (95% CI 0-2.1%) in low-risk T1 CRC vs. 4.4% (95% CI 2.7-6.5%) in high-risk T1 CRC (P=0.04). Overall adverse outcome rate (incomplete resection or metastasis) was 2.1% (95% CI 0-5.0%) in low-risk T1 CRC vs. 11.7% (95% CI 8.8-14.6%) in high-risk T1 CRC (P=0.001). Piecemeal resection (adjusted odds ratio 2.60; 95% CI 1.20-5.61, P=0.02) and non-pedunculated morphology (adjusted odds ratio 2.18; 95% CI 1.01-4.70, P=0.05) were independent risk factors for incomplete resection. Among patients in whom no additional surgery was performed, who developed recurrent cancer, 41.7% (95% CI 20.8-62.5%) died as a result of recurrent cancer. CONCLUSIONS: In the absence of histological high-risk factors, a 'wait-and-see' policy with limited follow-up is justified. Piecemeal resection and non-pedunculated morphology are independent risk factors for incomplete endoscopic resection of T1 CRC.Am J Gastroenterol advance online publication, 21 March 2017; doi:10.1038/ajg.2017.58. |
| Databáze: | OpenAIRE |
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