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Victoria Arthursson– Institutionen för kliniska vetenskaper, Malmö
Title: Clinical management of locally excised T1 colorectal cancers
Main supervisor: Carl-Fredrik Rönnow
Reviewers: Marie-Louise Lydrup och Jonas Manjer
Abstract
Background
Local resection of T1 colorectal cancer (CRC) is an attractive alternative to surgical resection in selected cases, offering reduced morbidity, mortality, cost and preserved bowel continuity. However, optimal management of this growing group of patients, striving to reduce procedure related morbidity, mortality and cost with preserved oncologic outcome, is yet to be determined.
Research questions
- Study 1: Identify risk factors for lymph node metastases (LNM) in patients with T1 CRC undergoing surgical resection.
- Study 2: Cost comparison of endoscopic and surgical resection of T1 rectal cancer.
- Study 3: Identify risk factors for recurrence after endoscopic resection of T1 CRC.
- Study 4: Compare outcome after endoscopic submucosal dissection and endoscopic mucosal resection of T1 CRC performed at a tertiary endoscopic centre.
Preliminary results
- Study 1: Lymphovascular invasion (LVI), perineural invasion, mucinous subtype and age under 60-years were identifyed as independent risk factors for LNM in T1 CRC. In contrast, submucosalinvasion was only a dependent risk factor and not significant in multivariate analysis.
- Study 2: Endoscopic submucosal dissection had the lowest total 1- year cost compared to transanal endoscopic microsurgery and surgical resection in T1 rectal cancer, even when accounting for intensified follow-up and additional surgical resection in high-risk cases.
- Study 3: Risk of recurrence after endoscopic resection of T1 CRC was low and rectal location was the only independent risk factor for recurrence.
Significance
- Study 1: Depth of submucosal invasion was only a dependent risk factor of LNM and should not dictate whether subsequent surgery should be performed after endoscopic resection in T1 CRC. In contrast, LVI is the dominant risk factor of LNM and should be taken into the decision process regarding additional surgery.
- Study 2: The cost of ESD was significantly lower, compared to the alternatives, for T1 rectal cancer patients. Performing ESD on all patients with T1 rectal cancer is justifiable from a cost perspective, even when performing additional surgery on all high-risk cases.
- Study 3: Risk of recurrence after endoscopic resection of T1 CRC is low but rectal location is a significant risk factor of recurrence, suggesting strict surveillance in this group of patients.
Published studies
- Study 1: Lymphovascular infiltration, not depth of invasion, is the critical risk factor of metastases in early colorectal cancer: retrospective population-based cohort study on prospectively collected data, including validation. Annulas of Surgery.
- Study 2: Cost comparisons of endoscopic and surgical resection of stage T1 rectal cancer. Endoscopy international Open.
- Study 3: Risk of recurrence after endoscopic resection of nonpedunculated T1 colorectal cancer. Endoscopy
Om evenemanget
Plats:
Lilla konferensrummet, kirurgen, plan 3, Malmö
Kontakt:
victoria [dot] arthursson [at] med [dot] lu [dot] se