title: Long-term outcomes after resection for submucosal invasive colorectal cancers.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  We collected data on 549 patients with submucosal colon cancer and 209 patients 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 one of 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.
  
  
  RESULTS
  The rates of recurrence, disease-free survival, and overall survival in group A for submucosal colon and rectal cancer were 0% versus 6.3% (P < .05), 96% versus 90%, and 96% versus 89%, respectively. For group B, these values were 1.4% versus 16.2% (P < .01), 96% versus 77% (P < .01), and 98% versus 96%, respectively; local recurrence was observed in 5 patients (one 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% versus 4.5%, 97% versus 95%, and 99% versus 97%, respectively.
  
  
  CONCLUSIONS
  The risk for local recurrence was significantly higher in high-risk patients with submucosal rectal cancer than in patients with submucosal colon cancer when treated with only endoscopic resection. The addition of surgery is therefore recommended for patients with submucosal rectal cancer with pathologic features indicating a high risk of tumor progression; University Hospital Medical Network Clinical Trials Registry, Number: UMIN 000008635.
authors.affiliation: Department of Gastrointestinal Oncology & Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan. hikemats@east.ncc.go.jp
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ikematsu
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Yoda
authors.forename: Takahisa
authors.initials: T
authors.lastname: Matsuda
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Yamaguchi
authors.forename: Kinichi
authors.initials: K
authors.lastname: Hotta
authors.forename: Nozomu
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Takahiro
authors.initials: T
authors.lastname: Fujii
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Oono
authors.forename: Taku
authors.initials: T
authors.lastname: Sakamoto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakajima
authors.forename: Madoka
authors.initials: M
authors.lastname: Takao
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Shinohara
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Murakami
authors.forename: Takahiro
authors.initials: T
authors.lastname: Fujimori
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kaneko
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Saito
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D004724:Endoscopy; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery*; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D016896:Treatment Outcome