Department of General Surgery, Central Hospital of Haining, Zhejiang Province People's Hospital Haining Hospital, No.758 Chang'an Road, Chang'an Town, Haining, 314408, Zhejiang, China.
Int J Colorectal Dis. 2022 Feb;37(2):273-281. doi: 10.1007/s00384-021-04049-8. Epub 2021 Oct 30.
It remains unclear the effect of prior endoscopic resection (ER) on the secondary surgery (SS) for T1 colorectal cancer (CRC). This study aimed to compare the short- and long-term outcomes between primary surgery (PS) and ER followed by SS for T1 CRC.
A systematic literature search was performed in PubMed and Ovid for studies comparing PS with ER followed by SS for T1 colorectal cancer. The last search was performed on 18 May 2021. The primary outcomes were surgical parameters and the secondary outcomes were survival indicators. The meta-analysis was performed with Review Manager Software (version 5.3).
A total of fifteen studies published between 2013 and 2021 with 4349 patients were included in this meta-analysis finally. No significant difference was observed between the two groups for operative time (P = 0.75, WMD = 3.16, 95%CI [-15.88, 22.19], I = 64%), blood loss (P = 0.86, WMD = 12.33, 95%CI [-122.99, 147.65], I = 95%), and postoperative complications (P = 0.59, OR = 0.93, 95%CI [0.71, 1.22], I = 0%). Besides, the two groups showed comparable survival outcomes, including overall recurrence rate (P = 0.15, OR = 0.78, 95%CI [0.56, 1.09], I = 23%) and 5-year overall survival (P = 0.76, OR = 0.86, 95%CI [0.33, 2.25], I = 0%). In the subgroup analysis for studies with propensity matching score or lesions located in the rectum, the results were not changed.
ER followed by SS is feasible for T1 CRC with high-risk factors. The prior ER would not bring additional adverse effects to the SS. More advanced tools should be developed to improve the diagnostic accuracy for the high-risk factors before treatment for T1 CRC.
内镜下切除（ER）对 T1 结直肠癌（CRC）的二次手术（SS）的影响仍不清楚。本研究旨在比较原发性手术（PS）与 ER 后 SS 治疗 T1 CRC 的短期和长期结果。
在 PubMed 和 Ovid 中进行了系统的文献检索，以比较 PS 与 ER 后 SS 治疗 T1 结直肠癌的研究。最后一次搜索于 2021 年 5 月 18 日进行。主要结果是手术参数，次要结果是生存指标。采用 Review Manager 软件（版本 5.3）进行荟萃分析。
最终共纳入了 2013 年至 2021 年期间发表的 15 项研究，共 4349 例患者。两组之间手术时间（P=0.75，WMD=3.16，95%CI[-15.88，22.19]，I=64%）、出血量（P=0.86，WMD=12.33，95%CI[-122.99，147.65]，I=95%）和术后并发症（P=0.59，OR=0.93，95%CI[0.71，1.22]，I=0%）无显著差异。此外，两组的生存结果相似，包括总复发率（P=0.15，OR=0.78，95%CI[0.56，1.09]，I=23%）和 5 年总生存率（P=0.76，OR=0.86，95%CI[0.33，2.25]，I=0%）。在具有倾向评分匹配或病变位于直肠的研究的亚组分析中，结果未发生变化。
对于有高危因素的 T1 CRC，ER 后 SS 是可行的。先前的 ER 不会给 SS 带来额外的不良影响。应该开发更先进的工具来提高 T1 CRC 治疗前高危因素的诊断准确性。
