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Risk factors of recurrence in T1 colorectal cancers treated by endoscopic resection alone or surgical resection with lymph node dissection

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Abstract

Purpose

The recurrence of T1 colorectal cancers is relatively rare, and the prognostic factors still remain obscure. This study aimed to clarify the risk factors for recurrence in patients with T1 colorectal cancers treated by endoscopic resection (ER) alone or surgical resection (SR) with lymph node dissection, respectively.

Methods

We reviewed 930 patients with resected T1 colorectal cancers (mean follow-up, 52.3 months). Patients were divided into two groups: those who underwent ER alone (298 cases), and those who underwent initial or additional SR with lymph node dissection (632 cases). Group differences in recurrence-free survival were evaluated using the Kaplan–Meier method and log-rank test. Associations between recurrence and clinicopathological features were evaluated in Cox regression analyses; hazard ratios (HRs) were calculated for the total population and each group.

Results

Recurrence occurred in four cases (1.34%) in the ER group and six cases (0.95%) in the SR group (p = 0.32). Endoscopic resection, rectal location, and poor or mucinous (Por/Muc) differentiation were prognostic factors for recurrence in the total population. Por/Muc differentiation was prognostic factor in both groups. Female sex, depressed-type morphology, and lymphatic invasion were also prognostic factors in the ER group, but not in the SR group.

Conclusions

Endoscopic resection, rectal location, and Por/Muc differentiation are prognostic factors in the total population. For patients who undergo ER alone, female sex, depressed-type morphology, and lymphatic invasion are also risk factors for recurrence. For such patients, regional en-bloc surgery with lymph node dissection could reduce the risk of recurrence.

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Acknowledgments

The authors express great thanks to Chiaki Nishimura for helping with the statistical analyses, and to all members of the Digestive Disease Center Showa University Northern Yokohama Hospital.

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Authors and Affiliations

  1. Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki Chuo, Tsuzuki-ku, Yokohama, Kanagawa, 224-8503, Japan

    Yuta Kouyama, Shin-ei Kudo, Hideyuki Miyachi, Katsuro Ichimasa, Shingo Matsudaira, Masashi Misawa, Yuichi Mori, Toyoki Kudo, Takemasa Hayashi, Kunihiko Wakamura, Fumio Ishida & Shigeharu Hamatani

  2. Department of Gastroenterology, Kakogawa Central City Hospital, Kakogawa, Japan

    Hideyuki Miyachi

  3. Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan

    Shigeharu Hamatani

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  1. Yuta Kouyama
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Kouyama, Y., Kudo, Se., Miyachi, H. et al. Risk factors of recurrence in T1 colorectal cancers treated by endoscopic resection alone or surgical resection with lymph node dissection. Int J Colorectal Dis 33, 1029–1038 (2018). https://doi.org/10.1007/s00384-018-3081-z

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