Endoscopic resection of stage T1 colorectal adenocarcinoma followed by surgical intervention: A single center retrospective study

Background: Domestic and international guidelines recommend endoscopic resection for stage T1 colorectal adenocarcinoma with indications. However, salvage surgery remains imperative for patients exhibiting high-risk factors subsequent to endoscopic procedures. Objective: To investigate the evidence, pathological features, and surgical outcomes of re-operation in patients with T1 colorectal adenocarcinoma following endoscopic resection. Methods: We retrospectively collect data on the clinical features and treatment outcomes of patients with stage T1 colorectal adenocarcinoma who underwent endoscopic resection followed by surgical resection and those who initially completed surgical intervention at Peking University International Hospital between January 2019 and October 2022. With the aim of assessing the necessity and feasibility of surgical intervention. Results: Seventeen patients (Group A) with high-risk factors following endoscopic procedure experienced further surgical resection. The median interval between endoscopic resection and re-operation was 23.71 ± 15.89 days. Sixteen patients (Group B) underwent radical resection without any prior interventions. The surgical approach involves integration of laparoscopy and colonoscopy for precise localization and quantitative diagnosis, followed by radical surgery. The two groups demonstrated significant differences statistically with reference to tumor diameter (1.65cm ± 0.77cm vs 3.36cm ± 1.39cm, P = 0.000) and the attainment of standard lymph node count (cases of detected lymph nodes larger than or equal to twelve, 5 vs 12, P = 0.015). Postoperative complications and hospital stay manifested no significant disparity statistically in two groups. Patients with salvage surgery had no inferior outcomes compared with patients with direct surgery in terms of 5-years disease-free survival (Log rank test: P = 0.083, Breslow test: P = 0.089). Conclusion: Remedial surgery is a safe and feasible treatment option for patients with T1 colorectal adenocarcinoma who cannot meet curative criteria after endoscopic treatment. Furthermore, subsequent treatment should be chosen based on a comprehensive analysis of the patient’s history of abdominal surgery, willingness, and pathological features. Trial registration: The registration number ChiCTR2300078246 can be found on the website http://www.chictr.org.cn.