Journal Article

Full-Thickness Scar Resection After R1/Rx Excised T1 Colorectal Cancers as an Alternative to Completion Surgery

Groen, John N., Spanier, Marcel B.W.M., Schreuder, Ramon-Michel, Haasnoot, Krijn J.C., Laclé, Miangela M., ter Borg, Frank, Schrauwen, Ruud W.M., Geesing, Joost M.J., Schwartz, Matthijs P., Moons, Leon M.G., Boersma, Femke, Gijsbers, Kim M., Bosman, Joukje H., Vleggaar, Frank P., de Vos tot Nederveen Cappel, Wouter H., van Berkel, Annemarie M., Bos, Philip R., van Westreenen, Erik H.L., Seerden, Tom J., Tuynman, Jurriaan B., Wolfhagen, Frank H.J., Terhaar Sive Droste, Jochim S., Dekker, Patty A.T., van der Schee, Lisa, Kessels, Koen, Elias, Sjoerd G., van Lent, Anja U.G., Backes, Yara, Boonstra, Jurjen J., Didden, Paul D.

2022

Overview

Local full-thickness resections of the scar (FTRS) after local excision of a T1 colorectal cancer (CRC) with uncertain resection margins is proposed as an alternative strategy to completion surgery (CS), provided that no local intramural residual cancer (LIRC) is found. However, a comparison on long-term oncological outcome between both strategies is missing. A large cohort of patients with consecutive T1 CRC between 2000 and 2017 was used. Patients were selected if they underwent a macroscopically complete local excision of a T1 CRC but positive or unassessable (R1/Rx) resection margins at histology and without lymphovascular invasion or poor differentiation. Patients treated with CS or FTRS were compared on the presence of CRC recurrence, a 5-year overall survival, disease-free survival, and metastasis-free survival. Of 3,697 patients with a T1 CRC, 434 met the inclusion criteria (mean age 66 years, 61% men). Three hundred thirty-four patients underwent CS, and 100 patients underwent FTRS. The median follow-up period was 64 months. CRC recurrence was seen in 7 patients who underwent CS (2.2%, 95% CI 0.9%-4.6%) and in 8 patients who underwent FTRS (9.0%, 95% CI 3.9%-17.7%). Disease-free survival was lower in FTRS strategy (96.8% vs 89.9%, P = 0.019), but 5 of the 8 FTRS recurrences could be treated with salvage surgery. The metastasis-free survival (CS 96.8% vs FTRS 92.1%, P = 0.10) and overall survival (CS 95.6% vs FTRS 94.4%, P = 0.55) did not differ significantly between both strategies. FTRS after local excision of a T1 CRC with R1/Rx resection margins as a sole risk factor, followed by surveillance and salvage surgery in case of CRC recurrence, could be a valid alternative strategy to CS.

• Publisher: Wolters Kluwer,Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
• Subject: Aged / Cancer / Cicatrix - pathology / Colorectal cancer / Colorectal Neoplasms - pathology / Colorectal Neoplasms - surgery / Endoscopy / Female / Gastroenterology / Humans / Laparoscopy / Male / Metastasis / Neoplasm Recurrence, Local - epidemiology / Neoplasm Staging / Patients / Retrospective Studies / Surgery / Surgical outcomes / Treatment Outcome