Imperial College London
Alternate

Chris Rao

Faculty of Medicine, Department of Surgery & Cancer

Honorary Clinical Research Fellow
 
 
 
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christopher.rao Website

 
 
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Summary

 

Publications

Citation

BibTex format

@article{Currie:2016:10.1016/j.gie.2016.05.014,
author = {Currie, AC and Askari, A and Rao, C and Saunders, BP and Athanasiou, T and Faiz, OD and Kennedy, RH},
doi = {10.1016/j.gie.2016.05.014},
journal = {Gastrointestinal Endoscopy},
title = {The potential impact of local excision for T1 colonic cancer in elderly and comorbid populations: a decision analysis.},
url = {http://dx.doi.org/10.1016/j.gie.2016.05.014},
year = {2016}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - BACKGROUND: Population-based bowel cancer screening has resulted in increasing numbers of patients with T1 colonic cancer. The need for colectomy in this group is questioned due to the low risk of lymphatic spread and increased treatment morbidity, particularly for elderly, comorbid patients. This study examined the quality-of-life benefits and risks of endoscopic resection compared with results after colectomy, for low-risk and high-risk T1 colonic cancer. METHODS: Decision analysis using a Markov simulation model was performed; patients were managed with either endoscopic resection (advanced therapeutic endoscopy) or colectomy. Lesions were considered high risk according to accepted national guidelines. Probabilities and utilities (perception of quality of life) were derived from published data. Hypothetical cohorts of 65- and 80-year-old, fit and unfit patients with low-risk or high-risk T1 colonic cancer were studied. The primary outcome was quality-adjusted life expectancy (QALE) in life-years (QALYs). RESULTS: In low-risk T1 colonic neoplasia, endoscopic resection increases QALE by 0.09 QALYS for fit 65-year-olds and by 0.67 for unfit 80-year-olds. For high-risk T1 cancers, the QALE benefit for surgical resection is 0.24 QALYs for fit 65-year-olds and the endoscopic QALE benefit is 0.47 for unfit 80-year-olds. The model findings only favored surgery with high local recurrence rates and when quality of life under surveillance was perceived poorly. CONCLUSIONS: Under broad assumptions, endoscopic resection is a reasonable treatment option for both low-risk and high-risk T1 colonic cancer, particularly in elderly, comorbid patients. Exploration of methods to facilitate endoscopic resection of T1 colonic neoplasia appears warranted.
AU  - Currie,AC
AU  - Askari,A
AU  - Rao,C
AU  - Saunders,BP
AU  - Athanasiou,T
AU  - Faiz,OD
AU  - Kennedy,RH
DO  - 10.1016/j.gie.2016.05.014
PY  - 2016///
SN  - 1097-6779
TI  - The potential impact of local excision for T1 colonic cancer in elderly and comorbid populations: a decision analysis.
T2  - Gastrointestinal Endoscopy
UR  - http://dx.doi.org/10.1016/j.gie.2016.05.014
ER  -
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