Endoscopy 2022; 54(05): 475-485
DOI: 10.1055/a-1637-9051
Original article

Endoscopic full-thickness resection of T1 colorectal cancers: a retrospective analysis from a multicenter Dutch eFTR registry

Liselotte W. Zwager*
 1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location AMC, Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, the Netherlands
,
Barbara A. J. Bastiaansen*
 1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location AMC, Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, the Netherlands
,
 2   Department of Gastroenterology and Hepatology, Noordwest Hospital Group, Alkmaar, the Netherlands
,
Dimitri N. Heine
 2   Department of Gastroenterology and Hepatology, Noordwest Hospital Group, Alkmaar, the Netherlands
,
Ramon M. Schreuder
 3   Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, the Netherlands
,
Lars E. Perk
 4   Department of Gastroenterology and Hepatology, Haaglanden Medical Center, the Hague, the Netherlands
,
Bas L. A. M. Weusten
 5   Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, the Netherlands
,
Jurjen J. Boonstra
 6   Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
,
Hedwig van der Sluis
 7   Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, the Netherlands
,
Hugo J. Wolters
 8   Department of Gastroenterology and Hepatology, Martini Hospital, Groningen, the Netherlands
,
Frank C. Bekkering
 9   Department of Gastroenterology and Hepatology, IJsselland Hospital, Capelle aan den IJssel, the Netherlands
,
Svend T. Rietdijk
10   Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
,
Matthijs P. Schwartz
11   Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, the Netherlands
,
Wouter B. Nagengast
12   Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
,
W. Rogier ten Hove
13   Department of Gastroenterology and Hepatology, Alrijne Medical Group, Leiden, the Netherlands
,
Jochim S. Terhaar sive Droste
14   Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, Den Bosch, the Netherlands
,
Francisco J. Rando Munoz
15   Department of Gastroenterology and Hepatology, Nij Smellinghe Hospital, Drachten, the Netherlands
,
Marije S. Vlug
16   Department of Gastroenterology and Hepatology, Dijklander Hospital, Hoorn, the Netherlands
,
Hanneke Beaumont
17   Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location VU, Amsterdam, the Netherlands
,
Martin H. M. G. Houben
18   Department of Gastroenterology and Hepatology, Haga Teaching Hospital, the Hague, the Netherlands
,
Tom C. J. Seerden
19   Department of Gastroenterology and Hepatology, Amphia Hospital, Breda, the Netherlands
,
Thomas R. de Wijkerslooth
20   Department of Gastroenterology and Hepatology, Antoni van Leeuwenhoek Hospital (NKI /AVL), Amsterdam, the Netherlands
,
Eric A. R. Gielisse
21   Department of Gastroenterology and Hepatology, Rode Kruis Hospital, Beverwijk, the Netherlands
,
Yark Hazewinkel
22   Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
,
Rogier de Ridder
23   Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, the Netherlands
,
Jan-Willem A. Straathof
24   Department of Gastroenterology and Hepatology, Maxima Medical Center, Eindhoven, the Netherlands
,
Manon van der Vlugt
 1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location AMC, Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, the Netherlands
,
Lianne Koens
25   Department of Pathology, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam, The Netherlands
,
Paul Fockens
 1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location AMC, Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, the Netherlands
,
Evelien Dekker
 1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location AMC, Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, the Netherlands
,
on behalf of the Dutch eFTR Group › Author Affiliations
Trial Registration: Netherlands National Trial Register Registration number (trial ID): NL5868 Type of study: Prospective multicenter study

Abstract

Background Complete endoscopic resection and accurate histological evaluation for T1 colorectal cancer (CRC) are critical in determining subsequent treatment. Endoscopic full-thickness resection (eFTR) is a new treatment option for T1 CRC < 2 cm. We aimed to report clinical outcomes and short-term results.

Methods Consecutive eFTR procedures for T1 CRC, prospectively recorded in our national registry between November 2015 and April 2020, were retrospectively analyzed. Primary outcomes were technical success and R0 resection. Secondary outcomes were histological risk assessment, curative resection, adverse events, and short-term outcomes.

Results We included 330 procedures: 132 primary resections and 198 secondary scar resections after incomplete T1 CRC resection. Overall technical success, R0 resection, and curative resection rates were 87.0 % (95 % confidence interval [CI] 82.7 %–90.3 %), 85.6 % (95 %CI 81.2 %–89.2 %), and 60.3 % (95 %CI 54.7 %–65.7 %). Curative resection rate was 23.7 % (95 %CI 15.9 %–33.6 %) for primary resection of T1 CRC and 60.8 % (95 %CI 50.4 %–70.4 %) after excluding deep submucosal invasion as a risk factor. Risk stratification was possible in 99.3 %. The severe adverse event rate was 2.2 %. Additional oncological surgery was performed in 49/320 (15.3 %), with residual cancer in 11/49 (22.4 %). Endoscopic follow-up was available in 200/242 (82.6 %), with a median of 4 months and residual cancer in 1 (0.5 %) following an incomplete resection.

Conclusions eFTR is relatively safe and effective for resection of small T1 CRC, both as primary and secondary treatment. eFTR can expand endoscopic treatment options for T1 CRC and could help to reduce surgical overtreatment. Future studies should focus on long-term outcomes.

* Both authors contributed equally to this article


Tables 1 s–4 s



Publication History

Received: 02 April 2021

Accepted: 06 September 2021

Publication Date:
06 September 2021 (online)

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany