Background
Population-based bowel cancer screening has resulted in increasing numbers of patients
with T1 colonic cancer. The need for colectomy in this group is questioned due to
the low risk of lymphatic spread and increased treatment morbidity, particularly for
elderly, comorbid patients. This study examined the quality-of-life benefits and risks
of endoscopic resection compared with results after colectomy, for low-risk and high-risk
T1 colonic cancer.
Methods
Decision analysis using a Markov simulation model was performed; patients were managed
with either endoscopic resection (advanced therapeutic endoscopy) or colectomy. Lesions
were considered high risk according to accepted national guidelines. Probabilities
and utilities (perception of quality of life) were derived from published data. Hypothetical
cohorts of 65- and 80-year-old, fit and unfit patients with low-risk or high-risk
T1 colonic cancer were studied. The primary outcome was quality-adjusted life expectancy
(QALE) in life-years (QALYs).
Results
In low-risk T1 colonic neoplasia, endoscopic resection increases QALE by 0.09 QALYS
for fit 65-year-olds and by 0.67 for unfit 80-year-olds. For high-risk T1 cancers,
the QALE benefit for surgical resection is 0.24 QALYs for fit 65-year-olds and the
endoscopic QALE benefit is 0.47 for unfit 80-year-olds. The model findings only favored
surgery with high local recurrence rates and when quality of life under surveillance
was perceived poorly.
Conclusions
Under broad assumptions, endoscopic resection is a reasonable treatment option for
both low-risk and high-risk T1 colonic cancer, particularly in elderly, comorbid patients.
Exploration of methods to facilitate endoscopic resection of T1 colonic neoplasia
appears warranted.
Abbreviations:
ESD (endoscopic submucosal dissection), HES (Hospital Episode Statistics dataset), JSCCR (Japanese Society for Cancer of the Colon and Rectum), NHS (National Health Service), QALE (quality-adjusted life expectancy), QALY (quality-adjusted life year), SD (standard deviation), SEER (Surveillance, Epidemiology, and End Results Program)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 14, 2016
Accepted:
May 9,
2016
Received:
November 4,
2015
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
Identification
Copyright
Copyright © 2016 by the American Society for Gastrointestinal Endoscopy
