TY - JOUR
T1 - Outcome of salvage surgery for colorectal cancer initially treated by upfront endoscopic therapy
AU - Nozawa, Hiroaki
AU - Ishihara, Soichiro
AU - Fujishiro, Mitsuhiro
AU - Kodashima, Shinya
AU - Ohtani, Kensuke
AU - Yasuda, Koji
AU - Nishikawa, Takeshi
AU - Tanaka, Toshiaki
AU - Tanaka, Junichiro
AU - Kiyomatsu, Tomomichi
AU - Kawai, Kazushige
AU - Hata, Keisuke
AU - Kazama, Shinsuke
AU - Sunami, Eiji
AU - Kitayama, Joji
AU - Watanabe, Toshiaki
N1 - Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2016/3/1
Y1 - 2016/3/1
N2 - Background Recent advances in endoscopic therapy, including conventional endoscopic resection and endoscopic submucosal dissection (ESD), have led to a large number of patients with early colorectal cancer (CRC) being cured; however, when resected specimens obtained by these procedures manifest risk factors for lymph node metastasis, additional treatments need to be considered. The aim of our study was to evaluate the outcomes of salvage surgery in CRC patients treated initially by advanced therapeutic endoscopy. Methods We investigated 145 patients who underwent salvage surgery in our department after endoscopic therapy for CRC between April 2006 and March 2015. Demographic and pathological data, endoscopic procedures, reasons for surgery, and operative outcomes, including perioperative details and recurrence-free and disease-specific survival after surgery, were analyzed. These data were further compared with those of 59 patients with submucosal invasive CRC treated by conventional endoscopic resection/ESD alone and 133 patients treated by surgery alone. Results Overall lymph node metastases were observed in 14% of patients who underwent salvage surgery after therapeutic endoscopy and 16% of those who received abdominal surgery alone. In analyses of surgical cases, patients with lymph node metastases more frequently included cases with lymphatic infiltration (63%) and ESD-treated cases (45%) than those without metastases (21%, P <.0001 and 22%, P =.02; respectively). A logistic regression analysis identified lymphatic infiltration as an independent predictive factor for lymph node metastases (odds ratio: 8.77, 95% confidence interval: 2.90-33.31, P <.0001). Long-term outcomes were favorable in both lymphatic infiltration-negative and positive cases. Moreover, survivals were comparable among the different treatment groups. Conclusion Because of the high rate of nodal involvement, adequate lymphadenectomy need to be performed in salvage surgery after upfront endoscopic therapy.
AB - Background Recent advances in endoscopic therapy, including conventional endoscopic resection and endoscopic submucosal dissection (ESD), have led to a large number of patients with early colorectal cancer (CRC) being cured; however, when resected specimens obtained by these procedures manifest risk factors for lymph node metastasis, additional treatments need to be considered. The aim of our study was to evaluate the outcomes of salvage surgery in CRC patients treated initially by advanced therapeutic endoscopy. Methods We investigated 145 patients who underwent salvage surgery in our department after endoscopic therapy for CRC between April 2006 and March 2015. Demographic and pathological data, endoscopic procedures, reasons for surgery, and operative outcomes, including perioperative details and recurrence-free and disease-specific survival after surgery, were analyzed. These data were further compared with those of 59 patients with submucosal invasive CRC treated by conventional endoscopic resection/ESD alone and 133 patients treated by surgery alone. Results Overall lymph node metastases were observed in 14% of patients who underwent salvage surgery after therapeutic endoscopy and 16% of those who received abdominal surgery alone. In analyses of surgical cases, patients with lymph node metastases more frequently included cases with lymphatic infiltration (63%) and ESD-treated cases (45%) than those without metastases (21%, P <.0001 and 22%, P =.02; respectively). A logistic regression analysis identified lymphatic infiltration as an independent predictive factor for lymph node metastases (odds ratio: 8.77, 95% confidence interval: 2.90-33.31, P <.0001). Long-term outcomes were favorable in both lymphatic infiltration-negative and positive cases. Moreover, survivals were comparable among the different treatment groups. Conclusion Because of the high rate of nodal involvement, adequate lymphadenectomy need to be performed in salvage surgery after upfront endoscopic therapy.
UR - http://www.scopus.com/inward/record.url?scp=84973577760&partnerID=8YFLogxK
U2 - 10.1016/j.surg.2015.09.008
DO - 10.1016/j.surg.2015.09.008
M3 - 記事
C2 - 26477474
AN - SCOPUS:84973577760
SN - 0039-6060
VL - 159
SP - 713
EP - 720
JO - Surgery (United States)
JF - Surgery (United States)
IS - 3
ER -
