Risk of recurrence following endoscopic resection of pedunculated vs non-pedunculated T1 colon cancer
Omar Aganbegovic, Tomas Vedin, Henrik Thorlacius, Carl-Fredrik RønnowAbstract
Introduction
Endoscopic resection has become an eligible alternative to surgery for early T1 colon cancer (CC), reducing morbidity and mortality. However, risk factors for recurrence following endoscopic resection of T1 CC remain unclear, and the role of tumor morphology, specifically pedunculated CC (PCC) versus non-pedunculated CC (NPCC), is scarcely studied. This study aims to investigate risk of recurrence in endoscopically resected T1 CC, comparing PCC versus NPCC.
Methods
Retrospective national cohort study on prospectively collected data from the Swedish Colorectal Cancer Registry for all patients with T1 CC undergoing endoscopic resection, 2008–2022. Uni- and multivariate Cox regression analysis were performed on factors, potentially influencing risk of recurrence (local and distant), comprising; tumor morphology (PCC versus NPCC), sex, age, tumor location, histological grade, lymphovascular invasion, perineural invasion, mucinous subtype, and tumor margins.
Results
In total, 33 (3.6%) of the 925 included patients were diagnosed with recurrences—7 local, 16 distant, 10 combined, with no significant difference between PCC (12/268, 4.5%) and NPCC (21/657, 3.2%). The 3- and 5-year DFI were 97.6 and 94.8% for PCC, and 99.0 and 97.3% for NPCC. Notably, recurrences were only observed in patients with T1 CC in the left colon 33/830 (4.0%) and none of the 95 patients with right sided or transverse colonic tumours had any recurrences.
Discussion
This study demonstrates that risk of recurrence following endoscopic resection of T1 CC is low, with no significant difference comparing PCC and NPCC. Risk factors used to dictate subsequent surgery, following endoscopic resection, were not statistically associated with recurrence.