Surgery vs. Endoscopic Resection for Early Colon Cancer — a randomized trial asking a critical question: can early colon cancer be treated with less burden, without compromising oncological safety?
ETHOS focuses on a growing challenge in colorectal cancer care. Screening programmes are detecting more early colon cancers, yet the current standard treatment remains surgery.
Surgery is effective, but it is also invasive, resource-intensive, and associated with complications and recovery burden. ETHOS evaluates whether a minimally invasive endoscopic procedure could safely replace surgery in selected patients with early-stage colon cancer.
For many patients with early colon cancer, the standard pathway still means removal of a segment of the bowel together with adjacent lymph nodes. Yet most patients with early-stage disease do not have nodal or distant metastases.
This creates a central clinical question: when is surgery necessary, and when might it represent more treatment than the patient actually needs? ETHOS addresses this question directly in patients with early colon cancer eligible for both approaches.
Screening programmes are detecting more early colon cancers. This means that decisions about how much treatment is truly necessary will affect a growing number of patients.
Current standard surgery is effective, but it carries complication risk, requires hospitalization, and places a significant burden on patients. Less invasive treatment could change that balance.
ETHOS looks beyond cancer control alone. The trial also considers adverse events, quality of life, patient burden, treatment costs, and organ preservation.
Broad implementation of less invasive treatment requires high-quality randomized evidence. ETHOS is designed to provide exactly that in early colon cancer.
Study hypothesis: eFTR provides similar oncological outcomes and a lower risk of adverse events compared with surgery.
ETHOS evaluates more than technical success or recurrence alone. Within ECOPOP, the trial also contributes to the assessment of patient burden, quality of life, treatment costs, and environmental footprint. This allows comparison of the two strategies in terms that matter both clinically and practically.
Randomized, controlled, multicentre, international trial.
438 patients across active study sites in Europe.
Moderate or severe adverse events within 30 days, and cancer recurrence or signs of metastases after 3 years.
Actively recruiting, with sites already engaged and patients randomized and treated. New sites continue to join.
Participation is voluntary and eligibility is assessed by the clinical team at a participating study site. ETHOS is intended for patients with early colon cancer who are technically eligible for both endoscopic and surgical treatment.
Patients are referred through participating clinical centres and assessed locally for eligibility before enrolment. Referral from a treating physician at an active study site is required.
Final eligibility is always determined individually by the study team according to the full protocol and clinical assessment.
Clinical centres interested in joining ETHOS as study sites, or physicians wishing to refer eligible patients, are welcome to contact the coordination team.
Clinical centres interested in joining ETHOS as study sites, or physicians wishing to refer eligible patients, are welcome to contact the coordination team.
Contact the teamQuestions about participation or site referral?
Email:
ecopop@gumed.edu.pl
Location:
Medical University of Gdańsk