Colon to Rectum
Am J Gastroenterol. 2022;117(4):647–53
Full-thickness scar resection after R1/Rx excised T1 colorectal cancers as an alternative to completion surgery
Introduction: 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.
Methods: 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.
Results: Of 3697 patients with a T1 CRC, 434 met the inclusion criteria (mean age 66 years, 61% men). 334 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% confidence interval [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.
Discussion: Full-thickness scar resection after local excision of a T1 colorectal cancer (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 completion surgery.