Recurrence and cancer-specific mortality after endoscopic resection of low- and high-risk pT1 colorectal cancers: a meta-analysis

• Published in: Gastrointestinal endoscopy Vol. 90; no. 4; pp. 559 - 569.e3
• Main Authors: Antonelli, Giulio, Vanella, Giuseppe, Orlando, Davide, Angeletti, Stefano, Di Giulio, Emilio
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2019
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Colonoscopy - methods; Colorectal Neoplasms - mortality; Colorectal Neoplasms - pathology; Colorectal Neoplasms - surgery; Humans; Incidence; Margins of Excision; Neoplasm Invasiveness; Neoplasm Recurrence, Local - epidemiology; Neoplasm Staging; CSM; CRC
• ISSN: 0016-5107; 1097-6779; 1097-6779
• DOI: 10.1016/j.gie.2019.05.045

Clinical management after complete endoscopic resection of pT1 colorectal cancers (CRCs) is still under debate. Follow-up data are heterogeneous and poorly reported, resulting in variable clinical management. Our aim was to meta-analyze recurrence and cancer-specific mortality (CSM) occurring after endoscopic resection of low- and high-risk pT1 CRCs undergoing conservative (nonsurgical) management. Literature was systematically searched until February 2019 for studies describing patients with pT1 CRCs, histologically classifiable as low or high risk, endoscopically resected without complementary surgery and with ≥12 months of follow-up. Pooled cumulative incidence (and incidence rate when specific follow-up intervals were available) of recurrence and CSM were calculated separately for low- and high-risk pT1 CRCs. Quality, publication bias, and heterogeneity were explored. Pooled cumulative incidences of recurrence and CSM among high-risk lesions (5 studies, 571 patients) were, respectively, 9.5% (95% confidence interval [CI], 6.7%-13.3%; I2 = 38.4%) and 3.8% (95% CI, 2.4%-5.8%; I2 = 0%), whereas among low-risk lesions (7 studies, 650 patients) they were, respectively, 1.2% (95% CI, .6%-2.5%; I2 = 0%) and .6% (95% CI, .2%-1.7%; I2 = 0%). Pooled incidence rates of recurrence and CSM among high-risk lesions (3 cohorts, 237 patients) were, respectively, 11 (95% CI, 2-20; I2 = 43.3%) and 4 (95% CI, 1-7; I2 = 0%) per 1000 patient-years, whereas among low-risk lesions (3 cohorts, 229 patients) they were 3 (95% CI, 0-6; I2 = 0%) and 2 (95% CI, 0-4; I2 = 0%) per 1000 patient-years, respectively. No publication bias or significant heterogeneity was found. Pooled estimates of adverse events after endoscopic resection of pT1 CRCs suggest a conservative approach for low-risk lesions. In high-risk lesions, increased surgical risk might justify a conservative management, whereas fitness for surgery makes surgical completion appropriate. [Display omitted]