Long-term outcomes after treatment for T1 colorectal carcinoma

Naoki Asayama, Shiro Oka, Shinji Tanaka, Yuki Ninomiya, Yuzuru Tamaru, Kenjiro Shigita, Nana Hayashi, Hiroyuki Egi, Takao Hinoi, Hideki Ohdan, Koji Arihiro, Kazuaki Chayama

Long-term outcomes of patients with T1 colorectal carcinoma (CRC) treated by endoscopic resection (ER) or surgical resection are unclear in relation to the curative criteria in the Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines. The aim of this study was to retrospectively compare the long-term outcomes among patients with T1 CRC in relation to the treatment methods. We examined 322 T1 CRC cases treated between January 1992 and August 2008 at Hiroshima University Hospital. Patients who did not meet the curative criteria in the JSCCR guidelines were defined as "non-endoscopically curable" and classified into three groups: underwent ER alone (group A: 45 patients), underwent additional surgery after ER (group B: 106 patients), and underwent surgical resection alone (group C: 92 patients). Of the 322 T1 CRC patients, 79 were categorized as endoscopically curable and 243 as non-endoscopically curable. Among the endoscopically curable T1 CRC patients, recurrence and 5-year OS rates were 0 and 94.2 %, respectively. In groups A, B, and C, recurrence rates were 4.4, 6.6, and 4.3 %, and OS rates were 85.6, 95.1, and 96.3 %, respectively (p < 0.05). Local recurrence or distant/lymph node metastasis was observed in 13 patients (group A: 2; group B: 7; group C: 4). Death due to primary CRC occurred in six patients (group B: 4; group C: 2). Long-term outcomes support the curative criteria according to the JSCCR guidelines. ER for T1 CRC did not worsen clinical outcomes in cases that required additional surgical resection.