Malene Broholm1, Martin Kobborg2, Erik Frostberg3, Maja Jeppesen4, Ismail Gögenür4. 1. Center for Surgical Science, Department of Surgery, Zealand University Hospital, Copenhagen University, København, Denmark. malenebroholm87@gmail.com. 2. Department of Surgery, Aabenraa Hospital, Aabenraa, Denmark. 3. Department of Surgery, Vejle Hospital, Vejle, Denmark. 4. Center for Surgical Science, Department of Surgery, Zealand University Hospital, Copenhagen University, København, Denmark.
Abstract
BACKGROUND: Self-expanding metal stents can be used as bridge to elective surgery for acute malignant colonic obstruction. However, the impact on long-term oncological outcome and the optimal timing of surgery are still unknown. METHOD: This was a retrospective multicenter study performed at four colorectal centers. Patients undergoing stent placement as bridge to surgery, between January 2010 and December 2013, were included in the study. Primary outcomes were survival and recurrence rates along with location of the metastases. Additionally, we recorded time from stent placement to elective surgery. Secondary outcomes were postoperative complication rates. Complications were classified according to the Clavien-Dindo classification score. A logistic regression model was used to describe impact of delayed stent removal on risk of recurrence. RESULTS: This study included 112 patients, with a median follow-up of 43 months. Survival rate was 70%. We found a recurrence rate of 37%, primarily local recurrences (17%). Procedure-related complications at the stent placement were seen in 18%, and complications after subsequent elective surgery were seen in 39%. A significantly higher risk of recurrence with increased time from stent placement to elective surgery (OR 5.1 [1.6-15.8], p = 0.005) was found. CONCLUSION: Delay of elective surgery after stent placement may have a negative influence on long-term oncologic outcomes.
BACKGROUND: Self-expanding metal stents can be used as bridge to elective surgery for acute malignant colonic obstruction. However, the impact on long-term oncological outcome and the optimal timing of surgery are still unknown. METHOD: This was a retrospective multicenter study performed at four colorectal centers. Patients undergoing stent placement as bridge to surgery, between January 2010 and December 2013, were included in the study. Primary outcomes were survival and recurrence rates along with location of the metastases. Additionally, we recorded time from stent placement to elective surgery. Secondary outcomes were postoperative complication rates. Complications were classified according to the Clavien-Dindo classification score. A logistic regression model was used to describe impact of delayed stent removal on risk of recurrence. RESULTS: This study included 112 patients, with a median follow-up of 43 months. Survival rate was 70%. We found a recurrence rate of 37%, primarily local recurrences (17%). Procedure-related complications at the stent placement were seen in 18%, and complications after subsequent elective surgery were seen in 39%. A significantly higher risk of recurrence with increased time from stent placement to elective surgery (OR 5.1 [1.6-15.8], p = 0.005) was found. CONCLUSION: Delay of elective surgery after stent placement may have a negative influence on long-term oncologic outcomes.
Entities:
Keywords:
Bridge to surgery; Oncological outcome; Self-expandable metal stents
Authors: Andrew S Miller; Kathryn Boyce; Benjamin Box; Matthew D Clarke; Sarah E Duff; Niamh M Foley; Richard J Guy; Lisa H Massey; George Ramsay; Dominic A J Slade; James A Stephenson; Phil J Tozer; Danette Wright Journal: Colorectal Dis Date: 2021-02 Impact factor: 3.917
Authors: Nora H Trabulsi; Hajar M Halawani; Esraa A Alshahrani; Rawan M Alamoudi; Sama K Jambi; Nouf Y Akeel; Ali H Farsi; Mohammed O Nassif; Ali A Samkari; Abdulaziz M Saleem; Nadim H Malibary; Mohammad M Abbas; Luca Gianotti; Antonietta Lamazza; Jin Young Yoon; Nada J Farsi Journal: Saudi J Gastroenterol Date: 2021 May-Jun Impact factor: 2.485