Jihye Park1, Hyun Jung Lee2,3, Soo Jung Park1, Hyuk Hur4, Byung Soh Min4, Jae Hee Cheon1, Tae Il Kim1, Nam Kyu Kim4, Won Ho Kim1. 1. Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea. 2. Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea. guswjd80@gmail.com. 3. Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea. guswjd80@gmail.com. 4. Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
Abstract
PURPOSE: Self-expandable metallic stents (SEMS) may be used in acute, obstructing, left-sided colorectal cancer (CRC) to avoid high-risk emergency surgery. However, the data regarding the long-term effects of SEMS as a bridge to surgery are limited and contradictory. Our aim is to analyze the long-term oncological outcomes of SEMS compared with surgery. METHODS: Between January 2006 and November 2013, a total of 855 patients with stage III CRC were regularly followed at the CRC clinic of Severance Hospital, Seoul, Korea. We retrospectively evaluated their 5-year disease-free survival (DFS), 5-year overall survival (OS), and 5-year cancer-specific survival (CSS). RESULTS: There were 94 patients in the SEMS group, 17 in the emergent-surgery group, and 744 in the elective-surgery group. In the short term, the rate of permanent stoma formation was significantly higher in the emergent-surgery group than in the SEMS group (p = 0.030), although the median hospital stay and overall complication rate were comparable. During the long-term follow-up period, oncological outcomes including 5-year DFS (70.2 vs 52.9%; p = 0.210), OS (70.2 vs 52.9%; p = 0.148), and CSS (79.8 vs 70.6%; p = 0.342) were not different between the SEMS group and the emergent-surgery group. Multivariate analysis showed emergent operation to be a significant risk factor of DFS (hazard ratio [HR], 3.117; 95% confidence interval [CI], 1.498-6.489; p = 0.002). CONCLUSIONS: Preoperative SEMS insertion does not adversely affect long-term oncological outcomes or patient survival.
PURPOSE: Self-expandable metallic stents (SEMS) may be used in acute, obstructing, left-sided colorectal cancer (CRC) to avoid high-risk emergency surgery. However, the data regarding the long-term effects of SEMS as a bridge to surgery are limited and contradictory. Our aim is to analyze the long-term oncological outcomes of SEMS compared with surgery. METHODS: Between January 2006 and November 2013, a total of 855 patients with stage III CRC were regularly followed at the CRC clinic of Severance Hospital, Seoul, Korea. We retrospectively evaluated their 5-year disease-free survival (DFS), 5-year overall survival (OS), and 5-year cancer-specific survival (CSS). RESULTS: There were 94 patients in the SEMS group, 17 in the emergent-surgery group, and 744 in the elective-surgery group. In the short term, the rate of permanent stoma formation was significantly higher in the emergent-surgery group than in the SEMS group (p = 0.030), although the median hospital stay and overall complication rate were comparable. During the long-term follow-up period, oncological outcomes including 5-year DFS (70.2 vs 52.9%; p = 0.210), OS (70.2 vs 52.9%; p = 0.148), and CSS (79.8 vs 70.6%; p = 0.342) were not different between the SEMS group and the emergent-surgery group. Multivariate analysis showed emergent operation to be a significant risk factor of DFS (hazard ratio [HR], 3.117; 95% confidence interval [CI], 1.498-6.489; p = 0.002). CONCLUSIONS: Preoperative SEMS insertion does not adversely affect long-term oncological outcomes or patient survival.
Entities:
Keywords:
Bridge to surgery; Colorectal neoplasms; Outcome; SEMS
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