AI Article Synopsis
- Population-based screening has led to more cases of T1 colonic cancer, raising questions about the necessity of colectomy due to low lymphatic spread risk and increased surgery-related complications, especially in older patients.
- A Markov simulation model was used to analyze the risks and quality-of-life benefits of endoscopic resection versus colectomy for both low-risk and high-risk T1 colonic cancer patients aged 65 and 80, assessing quality-adjusted life expectancy (QALE).
- Endoscopic resection generally provided greater QALE benefits for unfit elderly patients, suggesting it is a viable treatment option for T1 colonic cancer, highlighting the need for further exploration of this minimally invasive approach.
Article Abstract
Background: Population-based bowel cancer screening has resulted in increasing numbers of patients with T1 colonic cancer. The need for colectomy in this group is questioned due to the low risk of lymphatic spread and increased treatment morbidity, particularly for elderly, comorbid patients. This study examined the quality-of-life benefits and risks of endoscopic resection compared with results after colectomy, for low-risk and high-risk T1 colonic cancer.
Methods: Decision analysis using a Markov simulation model was performed; patients were managed with either endoscopic resection (advanced therapeutic endoscopy) or colectomy. Lesions were considered high risk according to accepted national guidelines. Probabilities and utilities (perception of quality of life) were derived from published data. Hypothetical cohorts of 65- and 80-year-old, fit and unfit patients with low-risk or high-risk T1 colonic cancer were studied. The primary outcome was quality-adjusted life expectancy (QALE) in life-years (QALYs).
Results: In low-risk T1 colonic neoplasia, endoscopic resection increases QALE by 0.09 QALYS for fit 65-year-olds and by 0.67 for unfit 80-year-olds. For high-risk T1 cancers, the QALE benefit for surgical resection is 0.24 QALYs for fit 65-year-olds and the endoscopic QALE benefit is 0.47 for unfit 80-year-olds. The model findings only favored surgery with high local recurrence rates and when quality of life under surveillance was perceived poorly.
Conclusions: Under broad assumptions, endoscopic resection is a reasonable treatment option for both low-risk and high-risk T1 colonic cancer, particularly in elderly, comorbid patients. Exploration of methods to facilitate endoscopic resection of T1 colonic neoplasia appears warranted.
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| http://dx.doi.org/10.1016/j.gie.2016.05.014 | DOI Listing |
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