Does Local Excision Without Salvage Surgery Affect the Prognostic Outcome of Patients With Malignant Colorectal Polyp? A Long‐Term Survival Analysis

BACKGROUND AND AIM: Management of malignant colorectal polyp has been a treatment dilemma for clinicians. This study aims to evaluate the long-term survival outcome of patients with and without salvage surgery after local excision. METHODS: From January 2000 to December 2022, patients with T1 malignant colorectal polyp diagnosed after local excision managed by two institutions were included for retrospective review. After propensity score matching, disease-free, cancer-specific, and overall survival between local excision alone (LE alone) group and local excision with salvage surgery (LE + SS) group were compared using Kaplan-Meier curves and log-rank test. Multivariate analysis was performed with Cox regression model to identify independent risk factors affecting disease-free survival. RESULTS: 42.6 months. There was no significant difference in the 8-year disease-free survival (LE alone, 86.7%; LE + SS, 90.4%; p = 0.206), cancer-specific survival (LE alone, 94.4%; LE + SS, 100%; p = 0.114) and overall survival (LE alone, 84.1%; LE + SS, 90.5%; p = 0.400). Piecemeal resection (HR, 7.051; 95% CI, 1.856-26.794; p = 0.004) and two or more pathological risk factors (HR, 8.552; 95% CI, 1.058-69.095; p = 0.044) were independent risk factors for worse disease-free survival in multivariate analysis. Salvage surgery and presence of single risk factor alone were not associated with disease-free survival. CONCLUSION: Local excision alone is non-inferior to local excision followed by salvage surgery in terms of long-term oncological outcome. With better risk profile assessment, local excision alone can be a safe treatment option in patients with T1 colorectal cancer.