Risk for Incomplete Resection after Macroscopic Radical Endoscopic Resection of T1 Colorectal Cancer: A Multicenter Cohort Study.
The decision to perform secondary surgery after endoscopic resection of T1 colorectal cancer (CRC) depends on the risk of lymph node metastasis and the risk of incomplete resection. We aimed to examine the incidence and risk factors for incomplete endoscopic resection of T1 CRC after a macroscopic radical endoscopic resection.



Data from patients treated between 2000 and 2014 with macroscopic complete endoscopic resection of T1 CRC were collected from 13 hospitals. Incomplete resection was defined as local recurrence at the polypectomy site during follow-up or malignant tissue in the surgically resected specimen in case secondary surgery was performed. Multivariate regression analysis was performed to analyze factors associated with incomplete resection.



In total, 877 patients with a median follow-up time of 36.5 months (interquartile range 16.0-68.3) were included, in whom secondary surgery was performed in 358 patients (40.8%). Incomplete resection was observed in 30 patients (3.4%; 95% confidence interval (CI) 2.3-4.6%). Incomplete resection rate was 0.7% (95% CI 0-2.1%) in low-risk T1 CRC vs. 4.4% (95% CI 2.7-6.5%) in high-risk T1 CRC (P=0.04). Overall adverse outcome rate (incomplete resection or metastasis) was 2.1% (95% CI 0-5.0%) in low-risk T1 CRC vs. 11.7% (95% CI 8.8-14.6%) in high-risk T1 CRC (P=0.001). Piecemeal resection (adjusted odds ratio 2.60; 95% CI 1.20-5.61, P=0.02) and non-pedunculated morphology (adjusted odds ratio 2.18; 95% CI 1.01-4.70, P=0.05) were independent risk factors for incomplete resection. Among patients in whom no additional surgery was performed, who developed recurrent cancer, 41.7% (95% CI 20.8-62.5%) died as a result of recurrent cancer.



In the absence of histological high-risk factors, a 'wait-and-see' policy with limited follow-up is justified. Piecemeal resection and non-pedunculated morphology are independent risk factors for incomplete endoscopic resection of T1 CRC.
Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands.
Y
Y
Backes
Department of Gastroenterology and Hepatology, Isala, Zwolle, The Netherlands.
W H
WH
de Vos Tot Nederveen Cappel
Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands.
J
J
van Bergeijk
Department of Gastroenterology and Hepatology, Deventer Hospital, Deventer, The Netherlands.
F
F
Ter Borg
Department of Gastroenterology and Hepatology, Meander Medical Centre, Amersfoort, The Netherlands.
M P
MP
Schwartz
Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands.
B W M
BWM
Spanier
Department of Gastroenterology and Hepatology, Diakonessenhuis, Utrecht, The Netherlands.
J M J
JMJ
Geesing
Department of Gastroenterology and Hepatology, Flevo Hospital, Almere, The Netherlands.
K
K
Kessels
Department of Gastroenterology and Hepatology, Groene Hart Hospital, Gouda, The Netherlands.
M
M
Kerkhof
Department of Gastroenterology and Hepatology, Sint Jansdal Hospital, Harderwijk, The Netherlands.
J N
JN
Groen
Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
F H J
FHJ
Wolfhagen
Department of Gastroenterology and Hepatology, Amphia Hospital, Breda, The Netherlands.
T C J
TCJ
Seerden
Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, The Netherlands.
N
N
van Lelyveld
Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands.
G J A
GJA
Offerhaus
Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands.|Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands.
P D
PD
Siersema
Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands.
M M
MM
Lacle
Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands.
L M G
LMG
Moons
D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery*; D000368:Aged; D003082:Colectomy; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology* / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D057832:Watchful Waiting