Colorectal
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See the full rubric →Competing Mortality Redefines the Net Benefit of Additional Surgery After Endoscopic Resection for T1 Colorectal Cancer in Older Adults.
Clinical takeawayFor older adults (≥80y) with high-risk T1 CRC, weigh delayed oncologic benefit (10+ years) against immediate surgical risks; consider pathologic risk, frailty, comorbidity, and competing mortality. Avoid routine additional surgery in frail or comorbid patients.
What it foundMeta-analysis shows the survival advantage of additional surgery for T1 CRC in older adults (≥80y) only becomes evident after 10 years, while perioperative morbidity occurs immediately.
ContextRefines prior standard of recommending additional surgery for all high-risk T1 CRC by showing age-specific trade-offs in competing mortality.
Refinessuggested applicable standard· U.S. Multi-Society Task Force on Colorectal Cancer (Rex DK, Boland CR, Dominitz JA, et al.), "Colorectal Cancer Screening: Recommendations for Physicians and Patients From the U.S. Multi-Society Task Force on Colorectal Cancer," Gastroenterology, 2017
Decision at stakewhether to recommend additional surgery after endoscopic resection for T1 colorectal cancer in older adults
U.S. Multi-Society Task Force on Colorectal Cancer (Rex DK, Boland CR, Dominitz JA, et al.), "Colorectal Cancer Screening: Recommendations for Physicians and Patients From the U.S. Multi-Society Task Force on Colorectal Cancer," Gastroenterology, 2017 · reviewed 2026-07-23 ↗Begin average-risk colorectal cancer screening at age 45 using a patient-centered shared-decision modality choice, colonoscopy every 10 years (preferred) or annual FIT as Tier 1 options, with multi-target stool DNA every 3 years, CT colonography every 5 years, or flexible sigmoidoscopy every 5 to 10 years as Tier 2 alternatives. A positive stool-based test requires diagnostic colonoscopy, and stool tests should not be ordered for patients who would decline follow-up colonoscopy. Generally stop at age 75 with individualized decisions for ages 76-85 and no screening beyond 85.
Ichimasa K … Misawa M · Digestive Endoscopy : Official Journal of the Japan Gastroenterological Endoscopy Society · IF 5.2 · PubMed ↗