Prognosis following surgical resection versus local excision of stage pT1 colorectal cancer: a population-based cohort study: Surgical resection versus local excision for pT1 colorectal cancer

Rachael McBride, Blanaid Hicks, Helen Coleman, Maurice B. Loughrey, Anna Gavin, Philip Dunne, William Jeffrey Campbell

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Abstract

Aims
To evaluate patient management following stage pT1 colorectal cancer (CRC) diagnosis, and to determine if surgical resection improved outcome compared with local excision, within a population-based study.

Methods
Data were collected from the Northern Ireland Cancer Registry. Cases of stage pT1 CRC diagnosed from 2007 to 2012 were identified. Analyses were conducted using Cox proportional hazard models to calculate hazard ratios (HR) and 95% confidence intervals (CI) for cancer-specific and all-cause mortality for individuals undergoing formal surgery versus local excision.

Results
394 patients with pT1 CRC were included. Of these, 37.1% were treated by local resection, 36.8% had biopsy followed by surgery and 26.1% had local excision followed by surgery. There were 60 deaths over a mean 4.8 years of follow-up, including 10 CRC-specific deaths. An additional 12 patients had a CRC recurrence or metastases during follow-up. Of the CRC–specific deaths or recurrences, 27.3% had local excision only. Individuals treated by formal surgery did not have a reduced risk of CRC-specific death (adjusted HR=1.51, 95% CI 0.29, 7.89), but did have a reduced risk of all-cause mortality (adjusted HR=0.51 95% CI 0.30, 0.87) compared with those undergoing local excision only.

Conclusions
Patients with stage pT1 CRC undergoing formal surgery had a reduced risk of all-cause mortality compared with those treated by local excision only. However, this was not explained by a reduced risk of recurrence/disease-free survival or CRC death, and suggests that the observed benefits may simply reflect selection of a healthier patient population in the formal surgery group.
Original languageEnglish
JournalSurgeon-Journal of the royal colleges of surgeons of edinburgh and ireland
Early online date08 Aug 2019
DOIs
Publication statusEarly online date - 08 Aug 2019

Keywords

  • colon cancer
  • rectal cancer
  • surgery
  • epidemiology
  • treatment

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