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Outcome of Completion Surgery after Endoscopic Submucosal Dissection in Early-Stage Colorectal Cancer Patients. | LitMetric

AI Article Synopsis

  • The study examines the effects of endoscopic submucosal dissection (ESD) for T1 colorectal cancers (T1CRC), specifically comparing the outcomes of completion surgery after ESD to primary surgery.
  • A total of 411 patients were analyzed, revealing a 24.1% adverse event rate after completion surgery and a 21.3% rate after primary surgery, with no 90-day mortality in the completion group.
  • The results indicate that ESD does not negatively impact the morbidity or 90-day mortality rates associated with subsequent completion surgeries, suggesting it is a safe option for T1CRC treatment.

Article Abstract

T1 colorectal cancers (T1CRC) are increasingly being treated by endoscopic submucosal dissection (ESD). After ESD of a T1CRC, completion surgery is indicated in a subgroup of patients. Currently, the influence of ESD on surgical morbidity and mortality is unknown. The aim of this study was to compare 90-day morbidity and mortality of completion surgery after ESD to primary surgery. The completion surgery group consisted of suspected T1CRC patients from a multicenter prospective ESD database (2014-2020). The primary surgery group consisted of pT1CRC patients from a nationwide surgical registry (2017-2019). Patients with rectal or sigmoidal cancers were selected. Patients receiving neoadjuvant therapy were excluded. Propensity score adjustment was used to correct for confounders. In total, 411 patients were included: 54 in the completion surgery group (39 pT1, 15 pT2) and 357 in the primary surgery group with pT1CRC. Adverse event rate was 24.1% after completion surgery and 21.3% after primary surgery. After completion surgery 90-day mortality did not occur, though one patient died in the primary surgery group. After propensity score adjustment, lymph node yield did not differ significantly between the groups. Among other morbidity-related outcomes, stoma rate (OR 1.298 95%-CI 0.587-2.872, = 0.519) and adverse event rate (OR 1.162; 95%-CI 0.570-2.370, = 0.679) also did not differ significantly. A subgroup analysis was performed in patients undergoing rectal surgery. In this subgroup (37 completion and 136 primary surgery), these morbidity outcomes also did not differ significantly. In conclusion, this study suggests that ESD does not compromise morbidity or 90-day mortality of completion surgery.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10526268PMC
http://dx.doi.org/10.3390/cancers15184490DOI Listing

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