title: Long-term outcomes after treatment for T1 colorectal carcinoma: a multicenter retrospective cohort study of Hiroshima GI Endoscopy Research Group.
abstract: BACKGROUND
  We aimed to clarify the long-term outcomes of patients with T1 colorectal carcinoma (CRC) after endoscopic resection (ER) and surgical resection.
  
  
  METHODS
  We examined T1 CRC patients treated during 1992-2008 and who had ≥5 years of follow-up. Patients who did not meet the curative criteria after ER according to the Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines were defined as "non-endoscopically curable" and classified into three groups: ER alone (Group A: 121 patients), additional surgery after ER (Group B: 238 patients), and surgical resection alone (Group C: 342 patients). Long-term outcomes and predictors of recurrence were analyzed.
  
  
  RESULTS
  Of the 882 patients with T1 CRC, 701 were non-endoscopically curable. Among these patients, recurrence and 5-year overall survival (OS) rates were 0.6 and 91.1%, respectively. In Groups A, B, and C, recurrence rates were 5.0, 5.5, and 3.8%, OS rates were 79.3, 92.4, and 91.5% (p < 0.01), and 5-year disease-free survival (DFS) rates were 98.1, 97.9, and 98.5%, respectively. Thirty-two patients experienced local recurrence or distant/lymph node metastasis (Group A: 6; Group B: 13; Group C: 13) and 14 patients died of primary CRC (Group A: 3; Group B: 7; Group C: 4). Age ≥65 years, protruded gross type, positive lymphatic invasion, and high budding grade were significant predictors of recurrence in non-endoscopically curable patients.
  
  
  CONCLUSIONS
  Our findings supported the JSCCR criteria for endoscopically curable T1 CRC. ER for T1 CRC did not worsen the clinical outcomes of patients who required additional surgical resection.
authors.affiliation: Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
authors.forename: Yuzuru
authors.initials: Y
authors.lastname: Tamaru
authors.affiliation: Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan. oka4683@hiroshima-u.ac.jp.|Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan. oka4683@hiroshima-u.ac.jp.
authors.forename: Shiro
authors.initials: S
authors.lastname: Oka
authors.affiliation: Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Nagata
authors.affiliation: Department of Endoscopy, Hiroshima Prefectural Hospital, Hiroshima, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Hiraga
authors.affiliation: Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Kuwai
authors.affiliation: Department of Gastroenterology, JA Hiroshima General Hospital, Hiroshima, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Furudoi
authors.affiliation: Department of Internal Medicine, Hiroshimakinen Hospital, Hiroshima, Japan.
authors.forename: Tadamasa
authors.initials: T
authors.lastname: Tamura
authors.affiliation: Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Kunihiro
authors.affiliation: Department of Gastroenterology, Chugoku Rosai Hospital, Kure, Japan.
authors.forename: Hideharu
authors.initials: H
authors.lastname: Okanobu
authors.affiliation: Department of Gastroenterology, JA Onomichi General Hospital, Onomichi, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Nakadoi
authors.affiliation: Department of Gastroenterology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kanao
authors.affiliation: Department of Gastroenterology, Shobara Red Cross Hospital, Shobara, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Higashiyama
authors.affiliation: Department of Anatomical Pathology, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Arihiro
authors.affiliation: Department of Anatomical Pathology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Kuraoka
authors.affiliation: Faculty of Humanities, Hiroshima Shudo University, Hiroshima, Japan.
authors.forename: Fumio
authors.initials: F
authors.lastname: Shimamoto
authors.affiliation: Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Chayama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Prognosis; Recurrence; T1 colorectal carcinoma; Treatment