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DOI: 10.1055/s-0039-1681204
RECURRENCE AND CANCER-SPECIFIC MORTALITY DURING FOLLOW UP OF LOW-AND HIGH-RISK ENDOSCOPICALLY RESECTED PT1 COLORECTAL CANCERS: A META-ANALYISIS
Publication History
Publication Date:
18 March 2019 (online)
Aims:
Oncological radicality of endoscopic resection of pT1 colorectal cancers (CRCs) is still under debate. Need for subsequent surgery is defined by histopathological factors associated to increased risk of lymph-node metastasis. Data describing this risk are heterogeneous and based on small retrospective surgical series, while follow-up data of non-surgically resected lesions are poorly reported, resulting in a great variability in management of these patients.
Our aim was to meta-analyze recurrence and cancer-specific mortality (CSM) occurring during follow-up of patients with low- and high-risk endoscopically resected pT1-CRCs undergoing a conservative follow-up.
Methods:
The protocol was registered in PROSPERO (CRD42018110402). PubMed was searched until September 2018 for studies describing patients with pT1-CRCs, classifiable as low- or high-risk according to current knowledge, who were endoscopically resected without complementary surgery and underwent follow-up for at least 12 months. PRISMA methodology was used. 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.
Results:
Pooled cumulative incidence of recurrence and CSM among high-risk lesions (6 studies,586 patients) was respectively 10.4% [95% CI:7 – 15%; I2:51.8%] and 4.1% [CI:2.7 – 6.2%; I2:0], while among low-risk lesions (6 studies,529 patients) recurrence and CSM were respectively 1.3% [CI:0.6 – 2.8%; I2:0] and 0.8% [CI:0.3 – 2.1%; I2:0]. Pooled incidence rate of recurrence and CSM among high risk lesions (3 cohorts,237 patients) was 11 [CI:2 – 20; I2:43.3%] and 4 per 1000 patient-years [95% CI:1 – 7; I2:0] respectively, while among low risk lesions (3 cohorts,229 patients), recurrence and CSM was 3 [CI:0 – 6; I2:0] and 2 per 1000 patient-years [95%: CI 0 – 4; I2:0] respectively. No publication bias was found.
Conclusions:
Among patients with endoscopically resected pT1 CRCs, available data warrants a conservative approach for low-risk patients. In high-risk patients, advanced age or increased surgical risk may justify a prudent management.