Endoscopic resection as the first-line treatment for early colorectal cancer: comparison with surgery

Endoscopic resection has emerged as an alternative therapeutic option for selected cases of early colorectal cancer. However, even now, few data are available on the comparative effectiveness of endoscopic versus surgical resection of early colorectal cancer. The aim of our study was to compare the clinical outcomes in patients with early colorectal cancer who underwent endoscopic resection and those who underwent surgical resection.

292 early colorectal cancer lesions in 287 patients who were treated with either endoscopic resection or colorectal surgery (open or laparoscopic colorectal resection) between January 2005 and December 2010 were retrospectively analyzed. After excluding 54 deep submucosal lesions [and/or tumor budding (Grade 2 or 3)], a total of 168 lesions with mucosal/superficial submucosal invasion were treated by endoscopic resection, and 70 lesions with mucosal/superficial submucosal invasion were treated by colorectal surgery.

In the endoscopic resection group, the en bloc resection rate and the complete resection rate were 91.1 and 91.1%, respectively. In the colorectal surgery group, both the en bloc resection rate and the curative resection rate were 100%. However, using Log rank test in Kaplan-Meier curve, no significant difference in recurrence rate (including metachronous cancer) during the median follow-up period of 37 months (range, 6-98 months) was observed between the two groups (p = 0.647). In addition, a similar morbidity rate was observed for endoscopic resection compared with surgery (5.4 vs. 5.7%, p = 0.760). A significantly shorter hospital stay was observed in the endoscopic resection group than colorectal surgery group [median 2 days (range, 2-29) vs. median 10 days (range, 7-37), p < 0.001).

We suggest that endoscopic resection, being equally effective but less invasive than surgery, can be the first-line treatment for well selected early colorectal cancer.