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Article

pT1 Colorectal Cancer Detected in a Colorectal Cancer Mass Screening Program: Treatment and Factors Associated with Residual and Extraluminal Disease

1
Department of Gastroenterology, Hospital Universitario de Ourense, Rúa Ramón Puga 52-56, 32003 Ourense, Spain
2
Instituto de Investigación Sanitaria Galicia Sur, 36312 Ourense, Spain
3
Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, 32003 Ourense, Spain
4
Department of Preventive Medicine, Hospital Universitario de Ourense, 32003 Ourense, Spain
5
Dirección Xeral de Saúde Pública, Conselleria de Sanidade, 15781 Santiago de Compostela, Spain
*
Author to whom correspondence should be addressed.
Cancers 2020, 12(9), 2530; https://doi.org/10.3390/cancers12092530
Received: 21 July 2020 / Revised: 26 August 2020 / Accepted: 4 September 2020 / Published: 6 September 2020
(This article belongs to the Special Issue New Insights into Colorectal Cancer)
Our study has evaluated the burden of pT1 CRC (confined to submucosa) detected during the first round of a CRC screening program, the surgery related complications and the factors related to four relevant outcomes: initial endoscopic resection, surgery rescue and residual disease after endoscopic resection and, finally, extraluminal disease after surgical resection. 38% of the CRC were detected in this stage.74.9% were initially resected endoscopically and 43.8% did not require surgery. There were inhospital surgical complications in 30.7%, mainly mild with no death and complications after discharge in 16.3% of the patients Residual disease was detected in 12 (4.3%) after endoscopic resection and extraluminal disease in 18 (8.6%) patients after surgery. We have determined several variables independently associated with the four outcome variables evaluated.
The aim of this study is to describe the treatment of pT1 colorectal cancer (CRC) in a mass screening program, the surgery-related complications and the factors associated with residual disease after endoscopic resection and extraluminal disease after surgery. We included in this retrospective analysis all the pT1 CRC detected in the Galician CRC screening program between May 2013 and June 2019. We determined which variables were independently associated with the outcomes of the study through a multivariable logistic regression analysis. We included 370–354 pT1 N0(X), 16 pT1N1- out of the 971 CRC detected; 277 (74.9%) were resected endoscopically and 162 (43.8%) were not referred to surgery. There were surgical complications in 30.7% and 16.3% of the patients during hospitalization and after discharge. Residual disease was detected in 12 (4.3%) after endoscopic resection and extraluminal disease in 18 (8.6%) patients after surgery. The variables independently associated with initial endoscopic resection were a pedunculated morphology (OR 33.1, 95% CI 4.3–254), a diameter ≥ 20 mm (OR 3.94, 95% CI 1.39–11.18) and a Site–Morphology–Size–Access score < 9 (OR 428, 95% CI 42–4263). The variables related with surgery rescue were a piecemeal resection (OR 4.48, 95% CI 1.48–13.6), an infiltrated/nonevaluable resection border (OR 7.44, 95% CI 2.12–26.0), a non-well-differentiated histology (OR 4.76, 95% CI 1.07–20.0), vascular infiltration (OR 8.24, 95% CI 2.72–25.0) and a Haggitt 4 infiltration of the submucosa (OR 5.68, 95% CI 2.62–12.3). Residual disease after endoscopic resection was associated with an infiltrated/nonevaluable resection border (OR 34.9, 95% CI 4.08–298), a non-well-differentiated histology (OR 6.67, 95% CI 1.05–50.0), and the vascular infiltration of the submucosa (OR 7.61, 95% CI 1.55–37.4). The variables related with extraluminal disease after surgical resection were no endoscopic resection (OR 4.34, 95% CI 1.26–14.28), a non-well-differentiated histology (OR 4.35, 95% CI 1.39–14.29) and the lymphatic infiltration of the submucosa (OR 4.8, 95% CI 1.32–17.8). In a CRC screening program, although most of pT1 CRC are candidates for endoscopic treatment, surgery is a safe procedure. We have defined some easy to evaluate variables that can be used in the decision-making process. View Full-Text
Keywords: colorectal cancer; screening; pT1; endoscopic resection; overtreatment; side effects colorectal cancer; screening; pT1; endoscopic resection; overtreatment; side effects
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MDPI and ACS Style

Cubiella, J.; González, A.; Almazán, R.; Rodríguez-Camacho, E.; Fontenla Rodiles, J.; Domínguez Ferreiro, C.; Tejido Sandoval, C.; Sánchez Gómez, C.; de Vicente Bielza, N.; Lorenzo, I.P.-R.; Zubizarreta, R. pT1 Colorectal Cancer Detected in a Colorectal Cancer Mass Screening Program: Treatment and Factors Associated with Residual and Extraluminal Disease. Cancers 2020, 12, 2530. https://doi.org/10.3390/cancers12092530

AMA Style

Cubiella J, González A, Almazán R, Rodríguez-Camacho E, Fontenla Rodiles J, Domínguez Ferreiro C, Tejido Sandoval C, Sánchez Gómez C, de Vicente Bielza N, Lorenzo IP-R, Zubizarreta R. pT1 Colorectal Cancer Detected in a Colorectal Cancer Mass Screening Program: Treatment and Factors Associated with Residual and Extraluminal Disease. Cancers. 2020; 12(9):2530. https://doi.org/10.3390/cancers12092530

Chicago/Turabian Style

Cubiella, Joaquín, Antía González, Raquel Almazán, Elena Rodríguez-Camacho, Juana Fontenla Rodiles, Carmen Domínguez Ferreiro, Coral Tejido Sandoval, Cristina Sánchez Gómez, Natalia de Vicente Bielza, Isabel Peña-Rey Lorenzo, and Raquel Zubizarreta. 2020. "pT1 Colorectal Cancer Detected in a Colorectal Cancer Mass Screening Program: Treatment and Factors Associated with Residual and Extraluminal Disease" Cancers 12, no. 9: 2530. https://doi.org/10.3390/cancers12092530

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