Prognostic Impact of Additional Surgery Following Endoscopic Resection for pT1 Colorectal Cancer in Patients Aged...

Additional resection is recommended for pT1 colorectal cancer at risk of lymph node metastasis. This study focused on postoperative complications and the impact on long-term outcomes in elderly patients with additional resection of pT1 colorectal cancer.

We retrospectively reviewed 607 patients who underwent R0 resection for pT1 colorectal cancer between 2016 and 2023. Patients were divided into an elderly group ≥ 80 years old (n = 108) and a nonelderly group < 80 years old (n = 498). After propensity score matching, 108 patients in each group were matched, and clinicopathological features and prognosis were analyzed.

Before matching, the elderly group included more females (p = 0.017) and showed a lower body mass index (p = 0.008) and higher frequencies of poor performance status (p = 0.001), comorbidities (p < 0.001), and postoperative complications (p = 0.002). After matching, postoperative complications were more frequent in the elderly group (28.7% vs. 15.7%, p = 0.032). Overall survival was significantly poorer in the elderly group with or without postoperative complications (78.0% vs. 91.8%, respectively; p = 0.037%), but not for the nonelderly group (91.7% vs. 85.0%, respectively; p = 0.706), and no differences were seen in recurrence-free survival.

Additional resection in patients ≥ 80 years old with poor performance status carries a high risk of postoperative complications and poor prognosis. Adequate perioperative management is essential, and indications for additional resection should be carefully evaluated.