Additional colectomy after colonoscopic polypectomy for T1 colon cancer: a fine balance between oncologic benefit and operative risk

Abstract

Purpose

The treatment of early-stage colorectal cancers removed endoscopically depends on histopathologic findings. This study aimed to assess the benefit–risk balance for patients who underwent additional surgery after endoscopic resection of a T1 carcinoma with unfavorable histology.

Methods

From 2000 to 2010, 64 consecutive patients were included in this retrospective study. Specimens resected after endoscopic polypectomy showed at least one of the following unfavorable factors: no free margin, lymphovascular invasion, poorly differentiated grade, SM2–3 involvement (submucosal invasion greater than 300 μm from the muscularis mucosae), tumor budding, sessile morphology, and piecemeal resection. The main objective was to assess the benefit–risk balance of an oncological resection performed after the polypectomy. Oncological benefit was measured by the lymph node metastasis rate and the persistence of a residual adenocarcinoma on the specimen. The risk was measured by the occurrence of severe complications of grade III–IV or death. The associations between these end points and clinicopathologic variables were evaluated by univariate analysis and logistic regression.

Results

Five patients (7.8 %) had lymph node metastases and two (3.1 %) had residual carcinomas. Eight patients (12.5 %) had grade III–IV morbidity. There were no deaths. Oncological benefit was associated by logistic regression analysis with patients who presented multiple criteria (≥2) that led to surgery (p = 0.031). The benefit–risk balance was favorable only for those patients.

Conclusions

Additional surgery is required for patients who present multiple adverse histological criteria. If only one criterion is selected, the indication should be discussed, especially for patients with multiple comorbidities.