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The effect of non-curative endoscopic resection on cT1N0M0 colorectal carcinoma patients who underwent additional surgery

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Abstract

Background and aim

Radical surgery is recommended for T1 colorectal cancer with non-curative endoscopic resection. However, there is still insufficient evidence about whether the non-curative endoscopic resection prior to surgical resection affects the short-term and long-term outcomes of patients. The purpose of this study was to investigate the effect of non-curative endoscopic resection before surgical resection on short-term and long-term outcomes in patients with T1 colorectal cancer.

Patients and methods

Patients with clinical T1N0M0 (cT1N0M0) colorectal cancer who underwent direct surgery or additional radical surgery after non-curative endoscopic resection were collected. We evaluated postoperative complications and long-term prognosis between the two groups.

Results

From 2011 to 2017, 779 patients were clinically diagnosed with T1N0M0 colorectal cancer at Zhongshan Hospital. We assessed patients who underwent additional surgery following the prior non-curative endoscopic resection (n = 145) and patients who underwent radical surgery directly (n = 336). There was no significant difference in 5-year OS (99.3% vs. 99.4%, P = 0.866) and 5-year DFS (97.2% vs. 97.3%, P = 0.909) between the two groups. The total complication rate was slightly higher in prior endoscopic resection group (15.2% vs. 9.5%, P = 0.111). The 5-year OS and 5-year DFS of patients who refused additional surgery (n = 95) were significantly lower than ER prior to surgery group (For OS, 92.6% vs. 99.3%, P = 0.017; for DFS, 91.2% vs. 97.2%, P = 0.021).

Conclusion

In patients who underwent additional surgery, non-curative endoscopic resection of cT1 colorectal carcinoma did not have adverse effect on short-term and long-term outcomes. Additional surgery should be recommended in patients who received non-curative ER.

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Acknowledgements

This study was supported by The National Natural Science Foundation of China (81602035, 81472228); The Shanghai Municipal Health Commission: Shanghai Outstanding Youth Specialist Training Program (Q2017-059); Clinical Science and Technology Innovation Project of Shanghai (SHDC12016104); and Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive (17DZ2252600).

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Author notes

  1. Yu Liu, Ran Li, Wenju Chang and Li Ren have equally contributed to this work.

Authors and Affiliations

  1. Colorectal Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China

    Yu Liu, Wenju Chang, Li Ren, Ye Wei, Tianyu Liu, Yijiao Chen, Yunshi Zhong & Jianmin Xu

  2. Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

    Yu Liu, Wenju Chang, Li Ren, Ye Wei, Tianyu Liu, Yijiao Chen, Yunshi Zhong & Jianmin Xu

  3. Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive, Shanghai, China

    Wenju Chang, Li Ren, Ye Wei, Yunshi Zhong & Jianmin Xu

  4. Endoscopic Center, Zhongshan Hospital, Fudan University, Shanghai, China

    Ran Li & Yunshi Zhong

  5. Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, China

    Minzhi Lv

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  1. Yu Liu
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  2. Ran Li
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  3. Wenju Chang
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  4. Li Ren
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  5. Ye Wei
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  6. Tianyu Liu
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  9. Yunshi Zhong
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Contributions

Yu Liu, Ran Li, Wenju Chang and Jianmin Xu designed the study, and were involved in patients’ management. Tianyu Liu and Yijiao Chen helped in the study design and revised the manuscript. Yunshi Zhong and Ran Li performed endoscopic resection. Li Ren, Ye Wei and Jianmin Xu performed surgical treatment. Yu Liu, Yijiao Chen and Minzhi Lv performed the statistical analyses. Yu Liu wrote the manuscript. Wenju Chang critically reviewed and revised the manuscript. All authors have read and approved the final version of the manuscript.

Corresponding authors

Correspondence to Yunshi Zhong or Jianmin Xu.

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Disclosure

Yu Liu, Ran Li, Wenju Chang, Li Ren, Ye Wei, Tianyu Liu, Yijiao Chen, Minzhi Lv, Yunshi Zhong, and Jianmin Xu have no conflicts of interest or financial ties to disclose.

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Liu, Y., Li, R., Chang, W. et al. The effect of non-curative endoscopic resection on cT1N0M0 colorectal carcinoma patients who underwent additional surgery. Surg Endosc 35, 2862–2869 (2021). https://doi.org/10.1007/s00464-020-07722-1

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  • DOI: https://doi.org/10.1007/s00464-020-07722-1

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