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

Nik Dekkers; Hao Dang; Jolein van der Kraan; Saskia le Cessie; Philip P Oldenburg; Jan W Schoones; Alexandra M J Langers; Monique E van Leerdam; Jeanin E van Hooft; Yara Backes; Katarina Levic; Alexander Meining; Giorgio M Saracco; Fabian A Holman; Koen C M J Peeters; Leon M G Moons; Pascal G Doornebosch; James C H Hardwick; Jurjen J Boonstra

doi:10.1007/s00464-022-09396-3

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

Surg Endosc. 2022 Dec;36(12):9156-9168. doi: 10.1007/s00464-022-09396-3. Epub 2022 Jun 30.

Authors

Nik Dekkers^#¹, Hao Dang^#², Jolein van der Kraan², Saskia le Cessie³, Philip P Oldenburg², Jan W Schoones⁴, Alexandra M J Langers², Monique E van Leerdam², Jeanin E van Hooft², Yara Backes⁵, Katarina Levic⁶, Alexander Meining⁷, Giorgio M Saracco⁸, Fabian A Holman⁹, Koen C M J Peeters⁹, Leon M G Moons⁵, Pascal G Doornebosch¹⁰, James C H Hardwick², Jurjen J Boonstra²

Affiliations

¹ Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands. n.dekkers@lumc.nl.
² Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
³ Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands.
⁴ Directorate of Research Policy (Formerly: Walaeus Library), Leiden University Medical Center, Leiden, The Netherlands.
⁵ Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
⁶ Gastrounit-Surgical Division, Center for Surgical Research, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark.
⁷ Department of Gastroenterology, University Hospital of Würzburg, Würzburg, Germany.
⁸ Division of Gastroenterology, Department of Medical Sciences, Molinette Hospital, University of Turin, Turin, Italy.
⁹ Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
¹⁰ Department of Surgery, IJsselland Hospital, Capelle Aan Den IJssel, The Netherlands.

^# Contributed equally.

Abstract

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%; I² = 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.

Keywords: Follow-up; Local surgical resection; Recurrence; T1 rectal cancer; Therapeutic endoscopy.

Publication types

Meta-Analysis

MeSH terms

Digestive System Surgical Procedures* / methods
Humans
Neoplasm Recurrence, Local / epidemiology
Neoplasm Recurrence, Local / pathology
Rectal Neoplasms* / pathology
Transanal Endoscopic Surgery*
Treatment Outcome