Surgical resection after endoscopic resection in patients with T1 colorectal cancer: a meta-analysis
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REVIEW
Surgical resection after endoscopic resection in patients with T1 colorectal cancer: a meta-analysis Yuan Tian 1 & Long Rong 1
&
Yongchen Ma 1
Accepted: 8 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Additional surgical resection (ASR) after endoscopic resection (ER) in patients with colorectal cancer (CRC) allows a complete staging and may decrease the recurrence rate, but no meta-analysis is available. This study aimed to compare the effectiveness of ER vs. ER + ASR as a treatment for patients with T1 (stage 1) CRC. Methods We performed a systematic search from databases (PubMed, Embase, and Cochrane library) for cohort studies published up to November 2019. The outcomes were overall survival (OS), local recurrence, recurrence, disease-specific survival, recurrence-free survival, and metastasis. Results Seven studies were included. There were 1205 patients in the ASR group and 993 patients in the ER group. Compared with ER, ASR was associated with better OS (OR = 0.31, 95% CI: 0.18–0.53, P < 0.001) and a borderline significant difference in lower local recurrence rates (OR = 0.29, 95% CI: 0.08–1.01, P = 0.052), but no differences were observed in recurrences, disease-specific survival, recurrence-free survival, and distant metastasis. A sensitivity analysis was performed; excluding each study sequentially from the pooled analysis did not affect the overall conclusion of the study. Conclusion Compared with ER, ASR after ER could improve the overall survival for patients with T1 CRC. Keywords Colorectal cancer . Endoscopic resection . Cancer surgery . Lymph nodes . Survival
Introduction Colorectal cancer (CRC) is one of the leading causes of mortality and morbidity worldwide. CRC is the third most common cancer and the fourth leading cause of cancer-related death [1]. The estimated number of new diagnoses of CRC was 1,800,977 in 2018 [2]. It mostly affects persons ≥ 60 years of age and men [1, 3]. Colonoscopy is the main screening method for CRC, and the prevalence of left-sided advanced CRC is reduced among patients who undergo screening colonoscopy [4]. The advantage of colonoscopy is that it allows immediate intervention in the case of incidental findings of polyps and early-stage CRC [5]. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00384-020-03752-2) contains supplementary material, which is available to authorized users. * Long Rong [email protected] 1
Department of Endoscopy Center, Peking University First Hospital, No. 8 Xishiku street, Xicheng District, Beijing 100034, China
Endoscopic resection (ER) is recommended to implement as a cure for CRC due to its minimal invasiveness for the diagnosis and treatment of CRC [3, 5]. The effectiveness and efficacy of ER for CRC treatment have been welldiscussed by previous studies [6–8]. On the other hand, ER is unable to provide the status of the regional lymph nodes [9]. According to previous studies, lymph node metastasis has been estimated to occur i
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