TY - JOUR
T1 - Full-Thickness Scar Resection after R1/Rx Excised T1 Colorectal Cancers as an Alternative to Completion Surgery
AU - Gijsbers, Kim M
AU - Laclé, Miangela M
AU - Elias, Sjoerd G
AU - Backes, Yara
AU - Bosman, Joukje H
AU - van Berkel, Annemarie M
AU - Boersma, Femke
AU - Boonstra, Jurjen J
AU - Bos, Philip R
AU - Dekker, Patty
AU - Didden, Paul D
AU - Geesing, Joost M J
AU - Groen, John N
AU - Haasnoot, Krijn J C
AU - Kessels, Koen
AU - van Lent, Anja U G
AU - van der Schee, Lisa
AU - Schrauwen, Ruud W M
AU - Schreuder, Ramon-Michel
AU - Schwartz, Matthijs P
AU - Seerden, Tom J
AU - Spanier, Marcel B W M
AU - Terhaar Sive Droste, Jochim S
AU - Tuynman, Jurriaan B
AU - de Vos Tot Nederveen Cappel, Wouter H
AU - van Westreenen, Erik H L
AU - Wolfhagen, Frank H J
AU - Vleggaar, Frank P
AU - Ter Borg, Frank
AU - Moons, Leon M G
N1 - Funding Information:
Financial support: This work was supported by a grant from the Dutch Digestive Diseases Foundation (reference MG/2015-040) and the Boks Scholten Foundation.
Publisher Copyright:
© 2022 Wolters Kluwer Health. All rights reserved.
PY - 2022/4/1
Y1 - 2022/4/1
N2 - INTRODUCTION: Local full-thickness resections of the scar (FTRS) after local excision of a T1 colorectal cancer (CRC) with uncertain resection margins is proposed as an alternative strategy to completion surgery (CS), provided that no local intramural residual cancer (LIRC) is found. However, a comparison on long-term oncological outcome between both strategies is missing.METHODS: A large cohort of patients with consecutive T1 CRC between 2000 and 2017 was used. Patients were selected if they underwent a macroscopically complete local excision of a T1 CRC but positive or unassessable (R1/Rx) resection margins at histology and without lymphovascular invasion or poor differentiation. Patients treated with CS or FTRS were compared on the presence of CRC recurrence, a 5-year overall survival, disease-free survival, and metastasis-free survival.RESULTS: Of 3,697 patients with a T1 CRC, 434 met the inclusion criteria (mean age 66 years, 61% men). Three hundred thirty-four patients underwent CS, and 100 patients underwent FTRS. The median follow-up period was 64 months. CRC recurrence was seen in 7 patients who underwent CS (2.2%, 95% CI 0.9%-4.6%) and in 8 patients who underwent FTRS (9.0%, 95% CI 3.9%-17.7%). Disease-free survival was lower in FTRS strategy (96.8% vs 89.9%, P = 0.019), but 5 of the 8 FTRS recurrences could be treated with salvage surgery. The metastasis-free survival (CS 96.8% vs FTRS 92.1%, P = 0.10) and overall survival (CS 95.6% vs FTRS 94.4%, P = 0.55) did not differ significantly between both strategies.DISCUSSION: FTRS after local excision of a T1 CRC with R1/Rx resection margins as a sole risk factor, followed by surveillance and salvage surgery in case of CRC recurrence, could be a valid alternative strategy to CS.
AB - INTRODUCTION: Local full-thickness resections of the scar (FTRS) after local excision of a T1 colorectal cancer (CRC) with uncertain resection margins is proposed as an alternative strategy to completion surgery (CS), provided that no local intramural residual cancer (LIRC) is found. However, a comparison on long-term oncological outcome between both strategies is missing.METHODS: A large cohort of patients with consecutive T1 CRC between 2000 and 2017 was used. Patients were selected if they underwent a macroscopically complete local excision of a T1 CRC but positive or unassessable (R1/Rx) resection margins at histology and without lymphovascular invasion or poor differentiation. Patients treated with CS or FTRS were compared on the presence of CRC recurrence, a 5-year overall survival, disease-free survival, and metastasis-free survival.RESULTS: Of 3,697 patients with a T1 CRC, 434 met the inclusion criteria (mean age 66 years, 61% men). Three hundred thirty-four patients underwent CS, and 100 patients underwent FTRS. The median follow-up period was 64 months. CRC recurrence was seen in 7 patients who underwent CS (2.2%, 95% CI 0.9%-4.6%) and in 8 patients who underwent FTRS (9.0%, 95% CI 3.9%-17.7%). Disease-free survival was lower in FTRS strategy (96.8% vs 89.9%, P = 0.019), but 5 of the 8 FTRS recurrences could be treated with salvage surgery. The metastasis-free survival (CS 96.8% vs FTRS 92.1%, P = 0.10) and overall survival (CS 95.6% vs FTRS 94.4%, P = 0.55) did not differ significantly between both strategies.DISCUSSION: FTRS after local excision of a T1 CRC with R1/Rx resection margins as a sole risk factor, followed by surveillance and salvage surgery in case of CRC recurrence, could be a valid alternative strategy to CS.
KW - Aged
KW - Cicatrix/pathology
KW - Colorectal Neoplasms/pathology
KW - Female
KW - Humans
KW - Male
KW - Neoplasm Recurrence, Local/epidemiology
KW - Neoplasm Staging
KW - Retrospective Studies
KW - Treatment Outcome
UR - https://www.scopus.com/pages/publications/85128159784
U2 - 10.14309/ajg.0000000000001621
DO - 10.14309/ajg.0000000000001621
M3 - Article
C2 - 35029166
SN - 0002-9270
VL - 117
SP - 647
EP - 653
JO - American Journal of Gastroenterology
JF - American Journal of Gastroenterology
IS - 4
ER -