Endoscopic electrocautery as a viable therapeutic option for early-stage colorectal cancer: A population-based cohort study

Background Technological advances have enabled endoscopic management of early-stage colorectal cancer (CRC) in preference to radical surgery; however, the indications remain largely unclear. This study aimed to explore the prevalence and outcomes of endoscopic electrocautery for CRC. Methods Patients diagnosed with early-stage primary CRC and treated with endoscopic electrocautery were retrospectively identified from the Surveillance, Epidemiology, and End Results program. Overall survival (OS) and disease-specific survival (DSS) were compared with those after segmental resection. Results A total of 1,648 CRC patients who underwent endoscopic electrocautery were included. In patients with Tis-stage rectal cancer (RC), endoscopic electrocautery provided more favorable OS and DSS than segmental resection (5-year OS: 89.6% vs. 86.5%, p = 0.037; 5-year DSS: 99.4% vs. 95.6%, p = 0.00086). In patients with Tis-stage colon cancer and T1-stage RC, endoscopic electrocautery exhibited similar OS and DSS to segmental resection ( Tis-stage colon cancer : 5-year OS: 86.2% vs. 89.7%, p = 0.12; T1-stage RC : 5-year OS: 90.6% vs. 89.9%, p = 0.98). For T1-stage colon cancer, there was significant oncological disadvantage after endoscopic electrocautery (5-year OS: 82.5% vs. 89.9%, p = 0.013). Conclusion For patients with Tis/T1-stage RC and Tis-stage colon cancer, endoscopic electrocautery was oncologically equivalent to segmental resection. Endoscopic electrocautery is a promising technique for early-stage CRC.