Surgical resection generally improves long-term outcomes over local resection in high-risk, T1 colorectal cancer (CRC), according to a meta-analysis published in Gastrointestinal Endoscopy.
The research also showed, however, that surgical resection may not improve outcomes at certain time points.
The meta-analysis included 12 retrospective studies of patients with T1 CRC. The studies encompassed 2961 patients — 831 who underwent local resection and 2130 who underwent surgical resection.
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Overall, the risk of death was higher among patients who underwent local resection than among those who underwent surgical resection (hazard ratio [HR], 1.93; 95% CI, 1.19-3.15; P =.010).
Overall survival (OS) rates were significantly higher in the surgical resection group at all time points assessed, as seen in the table below. In pooled analyses, patients in the local resection group had a higher risk of death at 5 years, 15 years, and 20 years but not at 10 years.
Overall, patients in the local resection group had a higher risk of cancer-related death than patients in the surgical resection group (HR, 2.31; 95% CI, 1.17-4.54; P =.020).
Rates of disease-specific survival (DSS) were significantly higher for the surgical resection group at all time points except 5 years. In pooled analyses, patients in the local resection group had a higher risk of death at 10 years and 15 years but not at 5 years or 20 years.
The risk of recurrence was higher with local resection than with surgical resection overall (HR, 3.51; 95% CI, 2.51-4.93; P =.010).
Recurrence-free survival (RFS) rates were significantly higher for the surgical resection group at all time points. In pooled analyses, patients in the local resection group had a higher risk of recurrence or death at all time points except 15 years.
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Outcomes by Treatment and Year |
||||
|
OS at 5 Years |
OS at 10 Years |
OS at 15 Years |
OS at 20 Years |
|
|
Local Resection |
86.30% |
72.93% |
61.80% |
61.80% |
|
Surgical Resection |
94.54% |
84.43% |
79.96% |
71.11% |
|
P value |
<.001 |
<.001 |
<.001 |
<.001 |
|
DSS at 5 Years |
DSS at 10 Years |
DSS at 15 Years |
DSS at 20 Years |
|
|
Local Resection |
96.65% |
86.92% |
86.92% |
86.92% |
|
Surgical Resection |
98.25% |
97.14% |
96.37% |
96.37% |
|
P value |
=.356 |
<.001 |
<.001 |
<.001 |
|
RFS at 5 Years |
RFS at 10 Years |
RFS at 15 Years |
RFS at 20 Years |
|
|
Local Resection |
89.85% |
83.33% |
83.33% |
29.57% |
|
Surgical Resection |
96.88% |
93.94% |
93.94% |
90.76% |
|
P value |
<.001 |
<.001 |
<.001 |
<.001 |
“[T]he outcomes of our meta-analysis may help clinicians to quantify the net benefits based on the actual risk and make individualized decisions for high-risk T1 CRC patients,” the researchers wrote.
Reference
Chen Y, Jing W, Chen M, et al. Long-term outcomes of local resection versus surgical resection for high-risk T1 colorectal cancer: A systematic review and meta-analysis. Gastrointest Endosc. Published online February 28, 2023. doi:10.1016/j.gie.2023.02.027
