EMR versus surgery for colon adenomas and early-stage cancers: a comparative effectiveness study

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Health Services Research

Background:

• Endoscopic mucosal resection (EMR) is standard for eligible colonic lesions, but its real-world performance in large U.S. populations is not well-established.
• Comparing EMR to surgery is crucial for optimizing patient care and resource allocation in community practices.

Purpose of the Study:

• To compare medical and healthcare utilization outcomes between colon EMR and surgical resection.
• To evaluate the safety and efficacy of EMR versus surgery for eligible colonic lesions in a community setting.

Main Methods:

• Retrospective cohort study of patients undergoing colon EMR or surgery between 2008 and 2017.
• Primary outcome: all-cause mortality. Secondary outcomes: recurrence rates and healthcare utilization.
• Follow-up duration: mean of 4.5 years.

Main Results:

• The study included 568 patients in the EMR group and 2054 in the surgical group.
• EMR group showed significantly lower all-cause mortality (HR, 0.31; P < .0001).
• All assessed healthcare utilization metrics were substantially lower in the EMR cohort (P < .0001).

Conclusions:

• In a community-based practice, colon EMR for eligible lesions is associated with significantly reduced all-cause mortality.
• EMR also leads to considerably lower healthcare utilization compared to surgical intervention.
• These findings support EMR as a favorable treatment option for select colonic lesions.