Additional Surgery versus Surveillance After Non-curative ESD for Early Colorectal Cancer: A Systematic Review and Reconstructed Individual Patient Data Meta-analysis
In brief
Additional surgery cuts overall death risk by two thirds after incomplete colorectal ESD
In a meta-analysis of 815 patients, patients who underwent surgery after a non-curative endoscopic resection had about a 60% lower risk of death from any cause compared with surveillance, and local tumor recurrence fell to one-sixth. Cancer-specific and distant recurrences were similar, so the benefit must be weighed against surgical risk, especially in older or frail patients.
- Journal
- Gastrointestinal endoscopy (Q1)
- Published
- 9 September 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Mohammad Al Hayek, Bisher Sawaf, Antonio Capogreco, Osamah Al Hayek, Obada Tarabichi, Nwal Hadaki, et al.
- PMID
- 42716253
- DOI
- 10.1016/j.gie.2026.08.052
Why clinicians should know about it
- Picked for Gastroenterology (paper of the day, 11 September 2026): Surgery vs surveillance after non‑curative ESD for early colorectal cancer
- Picked for Surgery (paper of the day, 11 September 2026): Additional surgery vs surveillance after non‑curative ESD
Abstract
BACKGROUND AND AIMS: Management after non-curative endoscopic submucosal dissection (ESD) for early colorectal cancer (CRC) remains controversial. We performed a pairwise and reconstructed individual patient data (IPD) meta-analysis to compare outcomes between surveillance and additional surgery. METHODS: A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted through March 25, 2026. Studies comparing surveillance versus additional surgery after non-curative ESD for CRC were included. Overall survival was the primary outcome and was analyzed as a time-to-event endpoint using reconstructed IPD from published Kaplan-Meier curves. Secondary outcomes included cancer-specific survival (time-to-event), overall recurrence, local recurrence, and distant recurrence. Random-effects models were applied using hazard ratios (HRs) and risk ratios (RRs) with 95% confidence intervals (CIs). RESULTS: Four studies with 815 patients were included. Additional surgery was associated with improved overall survival (HR, 0.37; 95% CI, 0.23-0.59), but not cancer-specific survival (HR, 0.63; 95% CI, 0.26-1.52). Overall recurrence did not differ significantly (RR, 0.44; 95% CI, 0.14-1.38), whereas local recurrence was lower with surgery (RR, 0.16; 95% CI, 0.04-0.63). No difference was observed in distant recurrence (RR, 0.65; 95% CI, 0.14-2.93). CONCLUSION: Additional surgery after non-curative ESD for colorectal cancer is associated with improved overall survival and reduced local recurrence, without significant differences in cancer-specific survival or distant recurrence. These findings highlight the importance of individualized treatment decisions that balance risk of surgery with risk of local recurrence and take into account patient preferences, particularly in patients with advanced age or comorbidities.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.