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Long-term outcomes of local resection versus surgical resection for high-risk T1 colorectal cancer: A systematic review and meta-analysis

  • Yuxiang Chen
    Affiliations
    Department of Gastroenterology and Hepatology, West China Hospital, Sichuan, University, Chengdu 610041, Sichuan, China

    Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, Department of Gastroenterology & Hepatology, West China Hospital, Sichuan, University, Chengdu 610041, Sichuan, China
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  • Weina Jing
    Affiliations
    Department of Gastroenterology and Hepatology, West China Hospital, Sichuan, University, Chengdu 610041, Sichuan, China

    Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, Department of Gastroenterology & Hepatology, West China Hospital, Sichuan, University, Chengdu 610041, Sichuan, China
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  • Mo Chen
    Affiliations
    Department of Gerontology, Tibetan Chengdu Branch Hospital of West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China

    Department of Gerontology, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu 610041, China
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  • Zhu Wang
    Affiliations
    Department of Gastroenterology and Hepatology, West China Hospital, Sichuan, University, Chengdu 610041, Sichuan, China

    Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, Department of Gastroenterology & Hepatology, West China Hospital, Sichuan, University, Chengdu 610041, Sichuan, China
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  • Junchao Wu
    Affiliations
    Department of Gastroenterology and Hepatology, West China Hospital, Sichuan, University, Chengdu 610041, Sichuan, China

    Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, Department of Gastroenterology & Hepatology, West China Hospital, Sichuan, University, Chengdu 610041, Sichuan, China
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  • Jinlin Yang
    Affiliations
    Department of Gastroenterology and Hepatology, West China Hospital, Sichuan, University, Chengdu 610041, Sichuan, China

    Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, Department of Gastroenterology & Hepatology, West China Hospital, Sichuan, University, Chengdu 610041, Sichuan, China
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  • Li Yang
    Affiliations
    Department of Gastroenterology and Hepatology, West China Hospital, Sichuan, University, Chengdu 610041, Sichuan, China

    Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, Department of Gastroenterology & Hepatology, West China Hospital, Sichuan, University, Chengdu 610041, Sichuan, China
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  • Kai Deng
    Correspondence
    Correspondence: Kai Deng, M.D., Tel.: 86-18980606867, Fax: 86-028-85423326, , Address: Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, 37 Guoxue Lane, 610041 Chengdu, China
    Affiliations
    Department of Gastroenterology and Hepatology, West China Hospital, Sichuan, University, Chengdu 610041, Sichuan, China

    Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, Department of Gastroenterology & Hepatology, West China Hospital, Sichuan, University, Chengdu 610041, Sichuan, China
    Search for articles by this author
Published:February 28, 2023DOI:https://doi.org/10.1016/j.gie.2023.02.027
Long-term outcomes of local resection versus surgical resection for high-risk T1 colorectal cancer: A systematic review and meta-analysis
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      Abstract

      Background and aims

      Patients with T1 colorectal cancer (CRC) are at high risk for lymph node metastasis and recurrence after local resection (LR) and need surgical resection (SR) for additional lymph node dissection to improve prognosis. However, the net benefits of SR and LR are still unquantified.

      Methods

      A systematic search for studies in which survival analysis among high-risk T1 CRC patients undergoing LR and SR was performed was conducted. Overall survival (OS), recurrence-free survival (RFS), and disease-specific survival (DSS) data were extracted. Hazard ratios (HRs) and fitted survival curves for OS, RFS and DSS were used to estimate the long-term clinical outcomes of patients in the two groups.

      Results

      This meta-analysis included 12 studies. Compared to those in the SR group, patients in the LR group had higher risks of death (HR 2.06, 95% CI 1.59-2.65), recurrence (HR 3.51, 95% CI 2.51-4.93) and cancer-related mortality (HR 2.31, 95% CI 1.17-4.54) in the long term. Fitted survival curves for the LR and SR groups revealed the 5-year, 10-year, and 20-year rates for OS (86.3%/94.5%, 72.9%/84.4%, and 61.8%/71.1%), RFS (89.9%/96.9%, 83.3%/93.9% and 29.6%/90.8%) and DSS (96.7%/98.3%, 86.9%/97.1% and 86.9%/96.4%, respectively). Log-rank tests showed significant differences among all the outcomes except for 5-year DSS.

      Conclusions

      For high-risk T1 CRC patients, the net benefit of DSS appears to be significant when the observation period exceeds 10 years. A long-term net benefit may exist but may not be applicable to all patients, especially high-risk patients with comorbidities. Therefore, LR may be a reasonable alternative for individualized treatment for some high-risk T1 CRC patients.

      Graphical abstract

      Figure thumbnail fx1
      Graphical Abstract

      Keywords

      Abbreviations used in this paper:

      CRC ((colorectal cancer)), LR ((local resection)), SR ((surgical resection)), OS ((overall survival)), RFS ((recurrence-free survival)), DSS ((disease-specific survival)), HRs ((hazard ratios))
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      Article info

      Publication history

      Accepted: February 21, 2023
      Received in revised form: February 16, 2023
      Received: October 25, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Conflicts of interest:

      The authors have no competing interests to declare.

      Author contributions

      Yuxiang Chen and Kai Deng contributed to the conception and design of the review. Yuxiang Chen wrote the first draft of the manuscript. Weina Jing, Zhu Wang, Junchao Wu, Jinlin Yang, Li Yang and Mo Chen wrote sections of the manuscript. All authors contributed to the revision of the manuscript and approved the submitted version.

      Funding statement

      The authors (Kai Deng and Jinlin Yang) were supported by the National Natural Science Foundation of China (No. 81600511 and No. 82173253), Science Foundation of the Sichuan Health and Family Planning Commission (No. 20PJYY0314), Sichuan Science and Technology Program (22ZDYF1618 and 2021YFH0005), 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University (2019-051 and 2021-150) and Operation Funding of Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer (No. 161200021).

      Identification

      DOI: https://doi.org/10.1016/j.gie.2023.02.027

      Copyright

      © 2023 by the American Society for Gastrointestinal Endoscopy

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