How Does Omitting Additional Surgery After Local Excision Affect the Prognostic Outcome of Patients With High-risk T1...

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• The necessity of additional surgery after local excision (LE) for high-risk T1 colorectal cancer (CRC) remains debated.
• Patient tolerability of invasive procedures influences treatment decisions.

Purpose of the Study:

• To evaluate the impact of omitting additional surgery on patient outcomes in high-risk T1 CRC.
• To compare outcomes between patients who underwent LE with additional surgery versus LE alone.

Main Methods:

• Analysis of patients with T1 CRC treated with LE between 2009-2016 at Japanese Society for Cancer of the Colon and Rectum institutions.
• Propensity score-matching to create one-to-one pairs of patients who received LE with surgery versus LE alone.
• Comparison of oncologic outcomes and survival rates between matched groups (401 pairs).

Main Results:

• Regional lymph node metastasis occurred in 7.7% of patients in the LE + surgery group.
• The LE-alone group showed low 5-year cumulative risks for local recurrence (4.1%) and overall recurrence (5.5%).
• A minimal difference in 5-year cancer-specific survival (1.8%) was observed, but 5-year overall survival was significantly lower in the LE-alone group (88.5% vs 94.5%).

Conclusions:

• Omitting additional surgery in dedicated CRC centers led to few oncologic events and satisfactory cancer-specific survival.
• Individualized risk assessment, considering non-oncologic adverse events, is crucial for optimal treatment strategies.
• Further evaluation is needed to balance oncologic control with non-oncologic risks for high-risk T1 tumors.