Long-Term Outcomes after Resection for Submucosal Invasive Colorectal Cancers
A partir de données portant sur 758 patients atteints d'un cancer du côlon ou du rectum avec envahissement de la sous-muqueuse (durée médiane de suivi supérieure à 60,5 mois), cette étude rétrospective évalue, du point de vue des taux de récidive, de la survie sans maladie et de la survie globale à 5 ans, l'efficacité à long terme d'une résection endoscopique combinée ou non à une résection chirurgicale en fonction des caractéristiques pathologiques de la maladie
Little is known about the long-term outcomes of patients with submucosal invasive colorectal cancer who undergo endoscopic or surgical resection. We performed a retrospective analysis of long-term outcomes of patients treated for submucosal colon and rectal cancer. We collected data from 549 patients with submucosal colon cancer and 209 with submucosal rectal cancer who underwent endoscopic or surgical resection at 6 institutions, over a median follow-up period of 60.5 months. Patients were classified into the following 3 groups: low-risk patients undergoing only endoscopic resection (Group A), high-risk patients undergoing only endoscopic resection (Group B), and high-risk patients undergoing surgical resection that included lymph node dissection (Group C). We assessed recurrence rates, 5-year disease free survival, and 5-year overall survival. Cox regression analysis was used to compare recurrences. The rates of recurrence, disease-free survival, and overall survival in Group A, for submucosal colon and rectal cancer, were 0% vs 6.3% ( P <.05), 96% vs 90%, and 96% vs 89%, respectively. For Group B, these values were 1.4% vs 16.2% ( P <.01), 96% vs 77% ( P <.01), and 98% vs 96%, respectively; local recurrence was observed in 5 patients (1 with submucosal colon cancer and 4 with submucosal rectal cancer). Tumor location was the only factor that contributed significantly to disease recurrence and death (hazard ratio, 6.73; P =.045). For Group C, these values were 1.9% vs 4.5%, 97% vs 85%, and 99% vs 97%, respectively. Of patients treated with only endoscopic resection, the risk for local recurrence was significantly higher in high-risk patients with submucosal rectal cancer than patients with submucosal colon cancer. The addition of surgery is therefore recommended for patients with submucosal rectal cancer with pathology features indicating a high risk of tumor progression. This study was registered in the University Hospital Medical Network Clinical Trials Registry (UMIN 000008635).
http://linkinghub.elsevier.com/retrieve/pii/S0016508512017465?showall=true