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Risk of recurrence after local resection of T1 rectal cancer: a meta-analysis with meta-regression

BACKGROUND: T1 rectal cancer (RC) patients are increasingly being treated by local resection alone but uniform surveillance strategies thereafter are lacking. To determine whether different local resection techniques influence the risk of recurrence and cancer-related mortality, a meta-analysis was...

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Autores principales: Dekkers, Nik, Dang, Hao, van der Kraan, Jolein, le Cessie, Saskia, Oldenburg, Philip P., Schoones, Jan W., Langers, Alexandra M. J., van Leerdam, Monique E., van Hooft, Jeanin E., Backes, Yara, Levic, Katarina, Meining, Alexander, Saracco, Giorgio M., Holman, Fabian A., Peeters, Koen C. M. J., Moons, Leon M. G., Doornebosch, Pascal G., Hardwick, James C. H., Boonstra, Jurjen J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9652303/
https://www.ncbi.nlm.nih.gov/pubmed/35773606
http://dx.doi.org/10.1007/s00464-022-09396-3
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author Dekkers, Nik
Dang, Hao
van der Kraan, Jolein
le Cessie, Saskia
Oldenburg, Philip P.
Schoones, Jan W.
Langers, Alexandra M. J.
van Leerdam, Monique E.
van Hooft, Jeanin E.
Backes, Yara
Levic, Katarina
Meining, Alexander
Saracco, Giorgio M.
Holman, Fabian A.
Peeters, Koen C. M. J.
Moons, Leon M. G.
Doornebosch, Pascal G.
Hardwick, James C. H.
Boonstra, Jurjen J.
author_facet Dekkers, Nik
Dang, Hao
van der Kraan, Jolein
le Cessie, Saskia
Oldenburg, Philip P.
Schoones, Jan W.
Langers, Alexandra M. J.
van Leerdam, Monique E.
van Hooft, Jeanin E.
Backes, Yara
Levic, Katarina
Meining, Alexander
Saracco, Giorgio M.
Holman, Fabian A.
Peeters, Koen C. M. J.
Moons, Leon M. G.
Doornebosch, Pascal G.
Hardwick, James C. H.
Boonstra, Jurjen J.
author_sort Dekkers, Nik
collection PubMed
description BACKGROUND: T1 rectal cancer (RC) patients are increasingly being treated by local resection alone but uniform surveillance strategies thereafter are lacking. To determine whether different local resection techniques influence the risk of recurrence and cancer-related mortality, a meta-analysis was performed. METHODS: A systematic search was conducted for T1RC patients treated with local surgical resection. The primary outcome was the risk of RC recurrence and RC-related mortality. Pooled estimates were calculated using mixed-effect logistic regression. We also systematically searched and evaluated endoscopically treated T1RC patients in a similar manner. RESULTS: In 2585 unique T1RC patients (86 studies) undergoing local surgical resection, the overall pooled cumulative incidence of recurrence was 9.1% (302 events, 95% CI 7.3–11.4%; I(2) = 68.3%). In meta-regression, the recurrence risk was associated with histological risk status (p < 0.005; low-risk 6.6%, 95% CI 4.4–9.7% vs. high-risk 28.2%, 95% CI 19–39.7%) and local surgical resection technique (p < 0.005; TEM/TAMIS 7.7%, 95% CI 5.3–11.0% vs. other local surgical excisions 10.8%, 95% CI 6.7–16.8%). In 641 unique T1RC patients treated with flexible endoscopic excision (16 studies), the risk of recurrence (7.7%, 95% CI 5.2–11.2%), cancer-related mortality (2.3%, 95% CI 1.1–4.9), and cancer-related mortality among patients with recurrence (30.0%, 95% CI 14.7–49.4%) were comparable to outcomes after TEM/TAMIS (risk of recurrence 7.7%, 95% CI 5.3–11.0%, cancer-related mortality 2.8%, 95% CI 1.2–6.2% and among patients with recurrence 35.6%, 95% CI 21.9–51.2%). CONCLUSIONS: Patients with T1 rectal cancer may have a significantly lower recurrence risk after TEM/TAMIS compared to other local surgical resection techniques. After TEM/TAMIS and endoscopic resection the recurrence risk, cancer-related mortality and cancer-related mortality among patients with recurrence were comparable. Recurrence was mainly dependent on histological risk status. GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00464-022-09396-3.
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spelling pubmed-96523032022-11-15 Risk of recurrence after local resection of T1 rectal cancer: a meta-analysis with meta-regression Dekkers, Nik Dang, Hao van der Kraan, Jolein le Cessie, Saskia Oldenburg, Philip P. Schoones, Jan W. Langers, Alexandra M. J. van Leerdam, Monique E. van Hooft, Jeanin E. Backes, Yara Levic, Katarina Meining, Alexander Saracco, Giorgio M. Holman, Fabian A. Peeters, Koen C. M. J. Moons, Leon M. G. Doornebosch, Pascal G. Hardwick, James C. H. Boonstra, Jurjen J. Surg Endosc Article BACKGROUND: T1 rectal cancer (RC) patients are increasingly being treated by local resection alone but uniform surveillance strategies thereafter are lacking. To determine whether different local resection techniques influence the risk of recurrence and cancer-related mortality, a meta-analysis was performed. METHODS: A systematic search was conducted for T1RC patients treated with local surgical resection. The primary outcome was the risk of RC recurrence and RC-related mortality. Pooled estimates were calculated using mixed-effect logistic regression. We also systematically searched and evaluated endoscopically treated T1RC patients in a similar manner. RESULTS: In 2585 unique T1RC patients (86 studies) undergoing local surgical resection, the overall pooled cumulative incidence of recurrence was 9.1% (302 events, 95% CI 7.3–11.4%; I(2) = 68.3%). In meta-regression, the recurrence risk was associated with histological risk status (p < 0.005; low-risk 6.6%, 95% CI 4.4–9.7% vs. high-risk 28.2%, 95% CI 19–39.7%) and local surgical resection technique (p < 0.005; TEM/TAMIS 7.7%, 95% CI 5.3–11.0% vs. other local surgical excisions 10.8%, 95% CI 6.7–16.8%). In 641 unique T1RC patients treated with flexible endoscopic excision (16 studies), the risk of recurrence (7.7%, 95% CI 5.2–11.2%), cancer-related mortality (2.3%, 95% CI 1.1–4.9), and cancer-related mortality among patients with recurrence (30.0%, 95% CI 14.7–49.4%) were comparable to outcomes after TEM/TAMIS (risk of recurrence 7.7%, 95% CI 5.3–11.0%, cancer-related mortality 2.8%, 95% CI 1.2–6.2% and among patients with recurrence 35.6%, 95% CI 21.9–51.2%). CONCLUSIONS: Patients with T1 rectal cancer may have a significantly lower recurrence risk after TEM/TAMIS compared to other local surgical resection techniques. After TEM/TAMIS and endoscopic resection the recurrence risk, cancer-related mortality and cancer-related mortality among patients with recurrence were comparable. Recurrence was mainly dependent on histological risk status. GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00464-022-09396-3. Springer US 2022-06-30 2022 /pmc/articles/PMC9652303/ /pubmed/35773606 http://dx.doi.org/10.1007/s00464-022-09396-3 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Article
Dekkers, Nik
Dang, Hao
van der Kraan, Jolein
le Cessie, Saskia
Oldenburg, Philip P.
Schoones, Jan W.
Langers, Alexandra M. J.
van Leerdam, Monique E.
van Hooft, Jeanin E.
Backes, Yara
Levic, Katarina
Meining, Alexander
Saracco, Giorgio M.
Holman, Fabian A.
Peeters, Koen C. M. J.
Moons, Leon M. G.
Doornebosch, Pascal G.
Hardwick, James C. H.
Boonstra, Jurjen J.
Risk of recurrence after local resection of T1 rectal cancer: a meta-analysis with meta-regression
title Risk of recurrence after local resection of T1 rectal cancer: a meta-analysis with meta-regression
title_full Risk of recurrence after local resection of T1 rectal cancer: a meta-analysis with meta-regression
title_fullStr Risk of recurrence after local resection of T1 rectal cancer: a meta-analysis with meta-regression
title_full_unstemmed Risk of recurrence after local resection of T1 rectal cancer: a meta-analysis with meta-regression
title_short Risk of recurrence after local resection of T1 rectal cancer: a meta-analysis with meta-regression
title_sort risk of recurrence after local resection of t1 rectal cancer: a meta-analysis with meta-regression
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9652303/
https://www.ncbi.nlm.nih.gov/pubmed/35773606
http://dx.doi.org/10.1007/s00464-022-09396-3
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