Early colorectal cancer diagnosed after endoscopic resection: Conservative treatment is safe in most of the cases. Proposal for a risk-based management.

Autores de IIS La Fe

• Jorge Sancho Muriel

  Autor

• Gianluca Pellino

  Autor

• Hanna Barbara Cholewa

  Autor

• Francisco Giner Segura

  Autor

• Marco Bustamante Balén

  Autor

• Eduardo García-Granero Ximénez

  Autor

• 

  Matteo Frasson

  Autor

Participantes ajenos a IIS La Fe

• Montesarchio L

Grupos

• Cirugía digestiva y Cuidados perioperatorios

• Endoscopia Digestiva y Hepática

Abstract

INTRODUCTION: Endoscopic resection offers advantages over surgical resection for early colorectal cancer (ECC). However, there might be a presumed risk of recurrence. We aimed to determine the risk of recurrence after endoscopic removal of ECC. METHODS: A single-centre series of endoscopic resections for ECC. Patients were stratified according to four risk factors: positive resection margins, Haggitt 4, lymphatic/vascular invasion and tumour budding. RESULTS: We included 127 patients. Haggitt classification was grade 4 in 54.0%. Positive margins were found in 43 (33.9%), 16 (12.6%) had lymphatic or vascular invasion, and 5 (4.0%) had high grade budding. In 82 (64.5%) endoscopic excision was the definitive treatment, 45 (35.4%) underwent surgery. Six patients (13.3%) had residual tumour on specimen and/or node metastases. Postoperative complications occurred in ten (22.2%). At a median follow-up of 63 months, none of the 82 patients treated with endoscopic resection alone had recurrence. After stratifying patients according to risk factors, those who had residual tumour also had =2 risk factors. CONCLUSIONS: Endoscopic follow up might be a valid option for patients with ECC. A risk-adjusted management seems prudent.

Copyright © 2022. Published by Elsevier España, S.L.U.

Keywords

• Cirugía; Cáncer colorrectal inicial; Early colorectal cancer; Endoscopia; Endoscopy; Factores de riesgo; Haggitt; Polipectomía; Polyp; Polypectomy; Pólipo; Risk factors; Surgery; Tratamiento; Treatment