Dekkers Nik, Dang Hao, Vork Katinka, Langers Alexandra M J, van der Kraan Jolein, Westerterp Marinke, Peeters Koen C M J, Holman Fabian A, Koch Arjun D, de Graaf Wilmar, Didden Paul, Moons Leon M G, Doornebosch Pascal G, Hardwick James C H, Boonstra Jurjen J
Department of Gastroenterology and Hepatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
Department of Surgery, Haaglanden Medical Center, 2512 VA The Hague, The Netherlands.
Cancers (Basel). 2023 Sep 9;15(18):4490. doi: 10.3390/cancers15184490.
T1 colorectal cancers (T1CRC) are increasingly being treated by endoscopic submucosal dissection (ESD). After ESD of a T1CRC, completion surgery is indicated in a subgroup of patients. Currently, the influence of ESD on surgical morbidity and mortality is unknown. The aim of this study was to compare 90-day morbidity and mortality of completion surgery after ESD to primary surgery. The completion surgery group consisted of suspected T1CRC patients from a multicenter prospective ESD database (2014-2020). The primary surgery group consisted of pT1CRC patients from a nationwide surgical registry (2017-2019). Patients with rectal or sigmoidal cancers were selected. Patients receiving neoadjuvant therapy were excluded. Propensity score adjustment was used to correct for confounders. In total, 411 patients were included: 54 in the completion surgery group (39 pT1, 15 pT2) and 357 in the primary surgery group with pT1CRC. Adverse event rate was 24.1% after completion surgery and 21.3% after primary surgery. After completion surgery 90-day mortality did not occur, though one patient died in the primary surgery group. After propensity score adjustment, lymph node yield did not differ significantly between the groups. Among other morbidity-related outcomes, stoma rate (OR 1.298 95%-CI 0.587-2.872, = 0.519) and adverse event rate (OR 1.162; 95%-CI 0.570-2.370, = 0.679) also did not differ significantly. A subgroup analysis was performed in patients undergoing rectal surgery. In this subgroup (37 completion and 136 primary surgery), these morbidity outcomes also did not differ significantly. In conclusion, this study suggests that ESD does not compromise morbidity or 90-day mortality of completion surgery.
T1期结直肠癌（T1CRC）越来越多地采用内镜黏膜下剥离术（ESD）进行治疗。T1CRC行ESD术后，部分患者需要进行根治性手术。目前，ESD对手术发病率和死亡率的影响尚不清楚。本研究旨在比较ESD术后根治性手术与一期手术的90天发病率和死亡率。根治性手术组由多中心前瞻性ESD数据库（2014 - 2020年）中疑似T1CRC患者组成。一期手术组由全国性手术登记处（2017 - 2019年）的pT1CRC患者组成。选择直肠或乙状结肠癌患者。排除接受新辅助治疗的患者。采用倾向评分调整来校正混杂因素。总共纳入411例患者：根治性手术组54例（39例pT1，15例pT2），一期手术组357例pT1CRC患者。根治性手术后不良事件发生率为24.1%，一期手术后为21.3%。根治性手术后未发生90天死亡，但一期手术组有1例患者死亡。经过倾向评分调整后，两组间淋巴结获取量无显著差异。在其他与发病率相关的结果中，造口率（OR 1.298，95%可信区间0.587 - 2.872，P = 0.519）和不良事件发生率（OR 1.162；95%可信区间0.570 - 2.370，P = 0.679）也无显著差异。对接受直肠手术的患者进行了亚组分析。在该亚组（37例根治性手术和136例一期手术）中，这些发病率结果也无显著差异。总之，本研究表明ESD不会影响根治性手术的发病率或90天死亡率。
