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01-11-2020 | Colorectal Cancer

Endoscopic resection of T1 colorectal cancer prior to surgery does not affect surgical adverse events and recurrence

Authors: Yusuke Yamaoka, Kenichiro Imai, Akio Shiomi, Hiroyasu Kagawa, Hitoshi Hino, Yushi Yamakawa, Tomohiro Yamaguchi, Yusuke Kinugasa, Yoshihiro Kishida, Sayo Ito, Kinichi Hotta, Toru Imai

Published in: Surgical Endoscopy | Issue 11/2020

Abstract

Background

Although a “no-touch isolation” technique is used in colorectal cancer surgery to reduce the risk of metastatic induction, endoscopic resection (ER) prior to surgery may work against this aim. This study evaluated the effects of initial ER on short- and long-term outcomes in T1 colorectal cancer.

Methods

This retrospective cohort study enrolled patients with pathological T1 colorectal cancer who underwent colorectal surgical resection at a Japanese tertiary cancer center between 2002 and 2012. A total of 548 eligible patients were divided into two groups: patients initially treated using surgical resection with lymph node dissection (LND) (primary group, n = 304) and patients treated using initial ER and additional surgical resection with LND (secondary group, n = 244). The inverse probability of treatment weighting (IPTW) method based on propensity score was used to compare postoperative complications and long-term recurrence.

Results

The incidence of postoperative complications with Clavien–Dindo classification grade ≥ II was 10.9% and 7.4% in the primary and secondary groups, respectively (p = 0.16). Multivariate analysis with a logistic proportional hazard regression model using IPTW revealed no significant differences in postoperative complications between the two groups (p = 0.79). During a median follow-up after surgery of 61.4 months, recurrence was observed in 3 (1.0%) and 8 (3.3%) patients, respectively (p = 0.06). Multivariate analysis with a Cox proportional hazard regression model using IPTW revealed no significant differences in recurrence between the two groups (p = 0.07).

Conclusion

Our results suggest no significant adverse effects of initial ER prior to surgery on surgical complications and long-term recurrence in T1 colorectal cancer.

Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68:394–424

Nishihara R, Wu K, Lochhead P, Morikawa T, Liao X, Qian ZR, Inamura K, Kim SA, Kuchiba A, Yamauchi M, Imamura Y, Willett WC, Rosner BA, Fuchs CS, Giovannucci E, Ogino S, Chan AT (2013) Long-term colorectal-cancer incidence and mortality after lower endoscopy. N Engl J Med 369:1095–1105CrossRef

Shaukat A, Mongin SJ, Geisser MS, Lederle FA, Bond JH, Mandel JS, Church TR (2013) Long-term mortality after screening for colorectal cancer. N Engl J Med 369:1106–1114CrossRef

Chiu HM, Chen HH (2015) Reply to Screening for colorectal cancer in Taiwan and France: does the fecal immunochemical test (FIT) fit? Cancer 12:4442–4443CrossRef

Baxter NN, Warren JL, Barrett MJ, Stukel TA, Doria-Rose VP (2012) Association between colonoscopy and colorectal cancer mortality in a US cohort according to site of cancer and colonoscopist specialty. J Clin Oncol 30:2664–2669CrossRef

Løberg M, Kalager M, Holme Ø, Hoff G, Adami HO, Bretthauer M (2014) Long-term colorectal-cancer mortality after adenoma removal. N Engl J Med 371:799–807CrossRef

Kubisch CH, Crispin A, Mansmann U, Göke B, Kolligs FT (2016) Screening for colorectal cancer is associated with lower disease stage: a population-based study. Clin Gastroenterol Hepatol 14:1612–1618CrossRef

van Gijn W, Marijnen CA, Nagtegaal ID, Kranenbarg EM, Putter H, Wiggers T, Rutten HJ, Påhlman L, Glimelius B, van de Velde CJ, Dutch Colorectal Cancer Group (2011) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol 12:575–582CrossRef

Bertelsen CA, Neuenschwander AU, Jansen JE, Wilhelmsen M, Kirkegaard-Klitbo A, Tenma JR, Bols B, Ingeholm P, Rasmussen LA, Jepsen LV, Iversen ER, Kristensen B, Gögenur I, Danish Colorectal Cancer Group (2015) Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: a retrospective, population-based study. Lancet Oncol 16:161–168CrossRef

10.

Yoda Y, Ikematsu H, Matsuda T, Yamaguchi Y, Hotta K, Kobayashi N, Fujii T, Oono Y, Sakamoto T, Nakajima T, Takao M, Shinohara T, Fujimori T, Kaneko K, Saito Y (2013) A large-scale multicenter study of long-term outcomes after endoscopic resection for submucosal invasive colorectal cancer. Endoscopy 45:718–724CrossRef

11.

Ikematsu H, Yoda Y, Matsuda T, Yamaguchi Y, Hotta K, Kobayashi N, Fujii T, Oono Y, Sakamoto T, Nakajima T, Takao M, Shinohara T, Murakami Y, Fujimori T, Kaneko K, Saito Y (2013) Long-term outcomes after resection for submucosal invasive colorectal cancers. Gastroenterology 144:551–559CrossRef

12.

Sako T, Kudo SE, Miyachi H, Wakamura K, Igarashi K, Misawa M, Mori Y, Kudo T, Hayashi T, Katagiri A, Ishida F, Azuma T, Inoue H, Hamatani S (2018) A novel ability of endocytoscopy to diagnose histological grade of differentiation in T1 colorectal carcinomas. Endoscopy 50:69–74CrossRef

13.

Ferlitsch M, Moss A, Hassan C, Bhandari P, Dumonceau JM, Paspatis G, Jover R, Langner C, Bronzwaer M, Nalankilli K, Fockens P, Hazzan R, Gralnek IM, Gschwantler M, Waldmann E, Jeschek P, Penz D, Heresbach D, Moons L, Lemmers A, Paraskeva K, Pohl J, Ponchon T, Regula J, Repici A, Rutter MD, Burgess NG, Bourke MJ (2017) Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 49:270–297CrossRef

14.

Hashiguchi Y, Muro K, Saito Y, Ito Y, Ajioka Y, Hamaguchi T, Hasegawa K, Hotta K, Ishida H, Ishiguro M, Ishihara S, Kanemitsu Y, Kinugasa Y, Murofushi K, Nakajima TE, Oka S, Tanaka T, Taniguchi H, Tsuji A, Uehara K, Ueno H, Yamanaka T, Yamazaki K, Yoshida M, Yoshino T, Itabashi M, Sakamaki K, Sano K, Shimada Y, Tanaka S, Uetake H, Yamaguchi S, Yamaguchi N, Kobayashi H, Matsuda K, Kotake K, Sugihara K, Japanese Society for Cancer of the Colon and Rectum (2019) Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol. https://doi.org/10.1007/s10147-019-01485zCrossRefPubMedPubMedCentral

15.

Backes Y, Moss A, Reitsma JB, Siersema PD, Moons LM (2017) Narrow band imaging, magnifying chromoendoscopy, and gross morphological features for the optical diagnosis of T1 colorectal cancer and deep submucosal invasion: a systematic review and meta-analysis. Am J Gastroenterol 112:54–56CrossRef

16.

Kudo S, Rubio CA, Teixeira CR, Kashida H, Kogure E (2001) Pit pattern in colorectal neoplasia: endoscopic magnifying view. Endoscopy 33:367–373CrossRef

17.

Matsuda T, Fujii T, Saito Y, Nakajima T, Uraoka T, Kobayashi N, Ikehara H, Ikematsu H, Fu KI, Emura F, Ono A, Sano Y, Shimoda T, Fujimori T (2008) Efficacy of the invasive/non-invasive pattern by magnifying chromoendoscopy to estimate the depth of invasion of early colorectal neoplasms. Am J Gastroenterol 103:2700–2706CrossRef

18.

Turnbull RB Jr, Kyle K, Watson FR, Spratt J (1967) Cancer of the colon: the influence of the no-touch isolation technic on survival rates. Ann Surg 166:420–427CrossRef

19.

Turnbull RB Jr (1975) Current concepts in cancer. Cancer of the GI tract: colon, rectum, anus. The no-touch isolation technique of resection. JAMA 231:1181–1182CrossRef

20.

Kanemitsu Y, Komori K, Kimura K, Kato T (2013) D3 lymph node dissection in right hemicolectomy with a no-touch isolation technique in patients with colon cancer. Dis Colon Rectum 56:815–824CrossRef

21.

Uraoka T, Saito Y, Matsuda T, Ikehara H, Gotoda T, Saito D, Fujii T (2006) Endoscopic indications for endoscopic mucosal resection of laterally spreading tumours in the colorectum. Gut 55:1592–1597CrossRef

22.

Tanaka S, Oka S, Chayama K (2008) Colorectal endoscopic submucosal dissection: present status and future perspective, including its differentiation from endoscopic mucosal resection. J Gastroenterol 43:641–651CrossRef

23.

Bosman FT, Carneiro F, Hruban RH, Theise ND (2010) WHO classification of tumours of the digestive system. IARC, Lyon

24.

Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196CrossRef

25.

Nozawa H, Ishihara S, Fujishiro M, Kodashima S, Ohtani K, Yasuda K, Nishikawa T, Tanaka T, Tanaka J, Kiyomatsu T, Kawai K, Hata K, Kazama S, Sunami E, Kitayama J, Watanabe T (2016) Outcome of salvage surgery for colorectal cancer initially treated by upfront endoscopic therapy. Surgery 159:713–720CrossRef

26.

Asayama N, Oka S, Tanaka S, Ninomiya Y, Tamaru Y, Shigita K, Hayashi N, Egi H, Hinoi T, Ohdan H, Arihiro K, Chayama K (2016) Long-term outcomes after treatment for T1 colorectal carcinoma. Int J Colorectal Dis 31:571–578CrossRef

27.

Tamaru Y, Oka S, Tanaka S, Nagata S, Hiraga Y, Kuwai T, Furudoi A, Tamura T, Kunihiro M, Okanobu H, Nakadoi K, Kanao H, Higashiyama M, Arihiro K, Kuraoka K, Shimamoto F, Chayama K (2017) Long-term outcomes after treatment for T1 colorectal carcinoma: a multicenter retrospective cohort study of Hiroshima GI Endoscopy Research Group. J Gastroenterol 52:1169–1179CrossRef

28.

Belderbos TD, van Erning FN, de Hingh IH, van Oijen MG, Lemmens VE, Siersema PD (2017) Long-term recurrence-free survival after standard endoscopic resection versus surgical resection of submucosal invasive colorectal cancer: a population-based study. Clin Gastroenterol Hepatol 15:403–411CrossRef

29.

Watanabe D, Toyonaga T, Ooi M, Yoshizaki T, Ohara Y, Tanaka S, Kawara F, Ishida T, Morita Y, Umegaki E, Matsuda T, Sumi Y, Nishio M, Yokozaki H, Azuma T (2018) Clinical outcomes of deep invasive submucosal colorectal cancer after ESD. Surg Endosc 32:2123–2130CrossRef

30.

Imai K, Hotta K, Yamaguchi Y, Kakushima N, Tanaka M, Takizawa K, Kawata N, Matsubayashi H, Shimoda T, Mori K, Ono H (2016) Preoperative indicators of failure of en bloc resection or perforation in colorectal endoscopic submucosal dissection: implications for lesion stratification by technical difficulties during stepwise training. Gastrointest Endosc 83:954–962CrossRef

31.

Igarashi K, Hotta K, Imai K, Yamaguchi Y, Ito S, Kawata N, Tanaka M, Kakushima N, Takizawa K, Matsubayashi H, Endo M, Asakura K, Oishi T, Shimoda T, Ono H (2017) Can positron emission tomography detect colorectal adenomas and cancers? J Gastroenterol Hepatol 32:602–608CrossRef

32.

Yabuuchi Y, Imai K, Hotta K, Ito S, Kishida Y, Yamaguchi T, Shiomi A, Kinugasa Y, Yoshida M, Tanaka M, Kawata N, Kakushima N, Takizawa K, Ishiwatari H, Matsubayashi H, Ono H (2018) Higher incidence of metachronous advanced neoplasia in patients with synchronous advanced neoplasia and left-sided colorectal resection for colorectal cancer. Gastrointest Endosc 88:348–359CrossRef

33.

Iwai T, Imai K, Hotta K, Ito S, Yamaguchi Y, Kawata N, Tanaka M, Kakushima N, Takizawa K, Ishiwatari H, Matsubayashi H, Ono H (2019) Endoscopic prediction of advanced histology in diminutive and small colorectal polyps. J Gastroenterol Hepatol 34:397–403CrossRef

34.

Lunceford JK, Davidian M (2004) Stratification and weighting via the propensity score in estimation of causal treatment effects: a comparative study. Stat Med 23:2937–2960CrossRef

35.

Overwater A, Kessels K, Elias SG, Backes Y, Spanier BWM, Seerden TCJ, Pullens HJM, van den Blink A, Offerhaus GJA, van Bergeijk J, Kerkhof M, Geesing JMJ, Groen JN, van Lelyveld N, Ter Borg F, Wolfhagen F, Siersema PD, Lacle MM, Moons LMG, Dutch T1 CRC Working Group (2018) Endoscopic resection of high-risk T1 colorectal carcinoma prior to surgical resection has no adverse effect on long-term outcomes. Gut 67:284–290CrossRef

36.

Rickert A, Aliyev R, Belle S, Post S, Kienle P, Kähler G (2014) Oncologic colorectal resection after endoscopic treatment of malignant polyps: does endoscopy have an adverse effect on oncologic and surgical outcomes? Gastrointest Endosc 79:951–960CrossRef

37.

Nishida T, Egashira Y, Akutagawa H, Fujii M, Uchiyama K, Shibayama Y, Hirose Y (2014) Predictors of lymph node metastasis in T1 colorectal carcinoma: an immunophenotypic analysis of 265 patients. Dis Colon Rectum 57:905–915CrossRef

38.

Wada H, Shiozawa M, Katayama K, Okamoto N, Miyagi Y, Rino Y, Masuda M, Akaike M (2015) Systematic review and meta-analysis of histopathological predictive factors for lymph node metastasis in T1 colorectal cancer. J Gastroenterol 50:727–734CrossRef

39.

Yamaguchi T, Kinugasa Y, Shiomi A, Kagawa H, Yamakawa Y, Furutani A, Manabe S, Yamaoka Y, Hino H (2018) Oncological outcomes of robotic-assisted laparoscopic versus open lateral lymph node dissection for locally advanced low rectal cancer. Surg Endosc 32:4498–4505CrossRef

40.

Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y, Hamaguchi T, Hyodo I, Igarashi M, Ishida H, Ishiguro M, Kanemitsu Y, Kokudo N, Muro K, Ochiai A, Oguchi M, Ohkura Y, Saito Y, Sakai Y, Ueno H, Yoshino T, Fujimori T, Koinuma N, Morita T, Nishimura G, Sakata Y, Takahashi K, Takiuchi H, Tsuruta O, Yamaguchi T, Yoshida M, Yamaguchi N, Kotake K, Sugihara K, Japanese Society for Cancer of the Colon and Rectum (2012) Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int J Clin Oncol 17:1–29CrossRef

Title: Endoscopic resection of T1 colorectal cancer prior to surgery does not affect surgical adverse events and recurrence
Authors: Yusuke Yamaoka
Kenichiro Imai
Akio Shiomi
Hiroyasu Kagawa
Hitoshi Hino
Yushi Yamakawa
Tomohiro Yamaguchi
Yusuke Kinugasa
Yoshihiro Kishida
Sayo Ito
Kinichi Hotta
Toru Imai
Publication date: 01-11-2020
Publisher: Springer US
Keywords: Colorectal Cancer
Colorectal Cancer
Published in: Surgical Endoscopy / Issue 11/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-019-07295-8

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Endoscopic resection of T1 colorectal cancer prior to surgery does not affect surgical adverse events and recurrence

Abstract

Background

Methods

Results

Conclusion

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Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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