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FOR ELDERLY PATIENTS WITH T1 COLORECTAL CANCERS TREATED BY ENDOSCOPIC RESECTION, ARE ADDITIONAL SURGERIES WITH LYMPH NODE DISSECTION NECESSARY?

Hideyuki Miyachi 1, Shinei Kudo 1, Yuta Kouyama 1, Shingo Matsudaira 1, Yushi Ogawa 1, Kenichi Mochizuki 1, Yuki Takashina 1, Yuki Miyata 1, Osamu Shiina 1, Yuriko Morita 1, Tomoya Shibuya 1, Yutaro Ide 1, Yasuharu Maeda 1, Hiroki Nakamura 1, Yuichi Mori 2, Masashi Misawa 1, Noriyuki Ogata 1, Tomokazu Hisayuki 1, Takemasa Hayashi 1, Kunihiko Wakamura 1, Shunpei Mukai 1, Naruhiko Sawada 1, Fumio Ishida 1, Tetsuo Nemoto 1, Katsuro Ichimasa 1

Affiliations

1 Showa University Northern Yokohama Hospital, Yokohama, Japan

2 University of Oslo / Showa University, Oslo, Norway

Summary

AI Generated

In a retrospective study of 1461 T1 colorectal carcinoma patients, overall survival after endoscopic resection alone was significantly shorter than after surgery with nodal dissection in patients ≤75 years, but no significant survival difference was observed in patients >75 years.

Among 1461 T1 colorectal carcinoma patients followed for a mean of 77.1 months, overall survival was significantly shorter in the endoscopic resection alone group compared to the surgical resection group (p<0.01).
In patients ≤75 years old, overall survival was significantly shorter with endoscopic resection alone (p<0.01), while in patients >75 years old, no significant difference in overall survival was found between treatment groups (p=0.08).
The authors suggest that for elderly patients with T1 colorectal carcinomas, the indication for additional surgical resection with nodal dissection after endoscopic resection might be carefully considered.
Current criteria for additional surgery are based only on lymph node metastasis risk without consideration of prognosis, and it is unclear whether the same criteria should apply to elderly versus non-elderly patients.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Recent advances in endoscopic technology have allowed many T1 colorectal carcinomas (CRCs) to be resected endoscopically. After endoscopic resection (ER), we often wonder if we should perform an additional surgical resection (SR) with nodal dissection. At present, the indication of additional SR is based only on the risk of simultaneous lymph node metastasis, with no consideration of prognosis in mind. Although in particular elderly people generally have some complications and are more likely to die from other diseases, it is not clear whether the criteria for additional SR after ER should be the same as for non-elderly patients.

Aims & Methods

The aim of this study is to investigate the overall survival (OS) in patients with T1 CRCs treated by ER alone or SR with nodal dissection. After excluding complications of advanced cancer or hereditary colorectal cancer and so on, we retrospectively analyzed 1461 patients with T1 CRCs resected ER or SR at our center from April 2001 to June 2020, and followed them up over a mean period of 77.1 months. We divided the patents into two groups: ER alone group and SR with lymph node dissection group, and compared the OS using the Kaplan–Meier method and the log-rank test. In addition, the same analysis was conducted by dividing the above subjects into those ≤ 75 years of the age and those > 75 years.

Results

In the overall T1 CRC patients, the OS was significantly shorter in the ER alone group than in the SR group (p < 0.01). Among those ≤ 75 years old, that was also shorter in the ER alone group (p < 0.01), while in those > 75 years, no significant difference was found in the OS (p = 0.08).

Conclusion

Among T1 CRC patients > 80 years of age, there was no difference in the remaining life expectancy, with or without SR with nodal dissection, even if additional SR was indicated after ER based on the current criteria. For elderly patients, T1 CRCs could be initially resected endoscopically, and the indication for additional SR with nodal dissection might be carefully considered.

Disclosure

Conference

UEG Week Copenhagen 2023

Topics

Colorectal

Submission format

Abstract

Session

PP 06 Other lower GI disorders (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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