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Impact of Surgery after Endoscopically Resected High-Risk T1 Colorectal Cancer: Results of an Emulated Target Trial.

GASTROINTESTINAL ENDOSCOPY(2024)

Cochin Hosp | Dupuytren Univ Hosp | Paris Cite Univ | Jean Mermoz Private Hosp | Paoli Calmettes Inst | Univ Hosp Geneva | Hosp Civils Lyon | Georges Pompidou European Hosp | Bercy Clin | Trocadero Clin | Anjou Clin | St Antoine Hosp | Pontchaillou Univ Hosp | Brabois Univ Hosp | Claude Huriez Hosp

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Abstract
BACKGROUND AND AIMS:We aimed to compare the long-term outcomes of patients with high-risk T1 colorectal cancer (CRC) resected endoscopically who received either additional surgery or surveillance.METHODS:We used data from routine care to emulate a target trial aimed at comparing 2 strategies after endoscopic resection of high-risk T1 CRC: surgery with lymph node dissection (treatment group) versus surveillance alone (control group). All patients from 14 tertiary centers who underwent an endoscopic resection for high-risk T1 CRC between March 2012 and August 2019 were included. The primary outcome was a composite outcome of cancer recurrence or death at 48 months.RESULTS:Of 197 patients included in the analysis, 107 were categorized in the treatment group and 90 were categorized in the control group. From baseline to 48 months, 4 of 107 patients (3.7%) died in the treatment group and 6 of 90 patients (6.7%) died in the control group. Four of 107 patients (3.7%) in the treatment group experienced a cancer recurrence and 4 of 90 patients (4.4%) in the control group experienced a cancer recurrence. After balancing the baseline covariates by inverse probability of treatment weighting, we found no significant difference in the rate of death and cancer recurrence between patients in the 2 groups (weighted hazard ratio, .95; 95% confidence interval, .52-1.75).CONCLUSIONS:Our study suggests that patients with high-risk T1 CRC initially treated with endoscopic resection may not benefit from additional surgery.
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T1 colorectal cancer,superficial colorectal cancer,endoscopic mucosal resection,endoscopic submucosal dissection,additional surgery
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要点】:研究比较了高风险T1期结直肠癌患者在内镜切除后接受额外手术与仅接受监测的长期预后,结果显示两组在死亡和癌症复发率上没有显著差异。

方法】:利用常规护理数据模拟目标试验,对比内镜切除后手术加淋巴结清扫(治疗组)与单独监测(对照组)两种策略。

实验】:纳入2012年3月至2019年8月间14家三级中心行内镜切除的高风险T1期CRC患者197例,其中治疗组107例,对照组90例,主要结局为48个月内的癌症复发或死亡,通过逆概率治疗加权平衡基线协变量后,比较两组的死亡和癌症复发率。