Endoscopy 2018; 50(04): S171
DOI: 10.1055/s-0038-1637557
ESGE Days 2018 ePosters
Georg Thieme Verlag KG Stuttgart · New York

MANAGEMENT OF ENDOSCOPICALLY RESECTED PT1 COLORECTAL CANCER. SURGERY OR FOLLOW UP? SINGLE CENTER EXPERIENCE, LONG TERM FOLLOW UP AND COST ANALYSIS

G Antonelli
1   Sant'Andrea University Hospital, Sapienza University of Rome, Endoscopy Unit, Rome, Italy
,
G Berardi
2   Sant'Andrea University Hospital, Sapienza University of Rome, General Surgery Unit, Rome, Italy
,
GL Rampioni Vinciguerra
3   Sant'Andrea University Hospital, Sapienza University of Rome, Pathology Department, Rome, Italy
,
V Domenico Corleto
1   Sant'Andrea University Hospital, Sapienza University of Rome, Endoscopy Unit, Rome, Italy
,
E Pilozzi
3   Sant'Andrea University Hospital, Sapienza University of Rome, Pathology Department, Rome, Italy
,
M Ruggeri
1   Sant'Andrea University Hospital, Sapienza University of Rome, Endoscopy Unit, Rome, Italy
,
G D'Ambra
1   Sant'Andrea University Hospital, Sapienza University of Rome, Endoscopy Unit, Rome, Italy
,
S Angeletti
1   Sant'Andrea University Hospital, Sapienza University of Rome, Endoscopy Unit, Rome, Italy
,
E Di Giulio
1   Sant'Andrea University Hospital, Sapienza University of Rome, Endoscopy Unit, Rome, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aims:

The spread of colorectal cancer (CRC) screening programs and the improvement of endoscopic techniques are incrementing the number of endoscopically treated pT1 CRC. The menace of lymphnode metastasis in presence of histopathological risk factors often requires additional surgery, but despite many guidelines, correct management remains variable and unclear. Our aim was to evaluate factors influencing therapeutic decision-making in endoscopically resected pT1 CRCs in a tertiary referral center, and analyze costs of different approaches.

Methods:

We reviewed data of patients undergoing endoscopic resection of pT1 CRC in our center from 2006 to 2016. Clinical, endoscopy, eventual subsequent surgery and follow up data were analyzed, as well as costs of all procedures, including in-hospital stay.

Results:

72 patients were included. 29 (40,2%) were followed up endoscopically whereas 43 (59,8%) were referred to subsequent surgery. Median age of endoscopy group (EG) was significantly higher than surgical group (SG), 74 (43 – 94) vs. 67 (36 – 83) (p = 0,008). EG had a higher mean Charlson Comorbidity Index (CCI), 3.1 ± 1.3 versus 2.3 ± 1.3 in the SG (p = 0.01). No differences were found between the two groups regarding histopathological characteristics, tumor site, dimension, morphology, pit and vascular patterns. 7 patients (16.2%) developed surgical complications with a mean hospital stay of 8 ± 5 days. After median follow up of 30 (6 – 130) months, no difference was found in overall survival within the two groups. At univariate analysis age, CCI and tumor budding were significantly associated to referral for surgery. At multivariate analysis, age and CCI were independently associated with subsequent surgery. Cost analysis revealed significant inferior costs of endoscopic resection and follow up approach, even when procedures required in-hospital stay.

Conclusions:

Management of endoscopically resected pT1 CRC in a real life setting is guided by patient characteristics rather than tumor features, including histopathological risk factors. When evaluating low risk patients, inferior costs of endoscopic approach should be considered.