Sung Il Kang1, Heung-Kwon Oh2, Jae Suk Yoo3, Soyeon Ahn4, Min Hyun Kim1, Myung Jo Kim1, Il Tae Son1, Duck-Woo Kim1, Sung-Bum Kang1, Young Soo Park5, Chang Jin Yoon6, Rumi Shin7, Seung Chul Heo7, In Taek Lee8, Eui Gon Youk8, Min Jung Kim9, Tae Young Chang9, Sung-Chan Park9, Dae Kyung Sohn9, Jae Hwan Oh9, Ji Won Park10, Seung-Bum Ryoo10, Seung-Yong Jeong10, Kyu Joo Park10. 1. Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea. 2. Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea. Electronic address: crsohk@gmail.com. 3. Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, South Korea. 4. Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, South Korea. 5. Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea. 6. Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea. 7. Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, South Korea. 8. Department of Surgery, Daehang Hospital, Seoul, South Korea. 9. Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea. 10. Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea.
Abstract
BACKGROUND: Colonic self-expanding metallic stenting (SEMS) is widely used for the treatment of malignant colonic obstruction as a bridge to elective surgery. However, the effects of colonic stenting on long-term oncologic outcomes are debatable. This study aimed to compare the long-term oncologic outcomes of preoperative SEMS insertion with those of immediate surgery in patients with obstructing left-sided colorectal cancer. METHODS: A cohort of consecutive patients who underwent radical surgery for obstructing left-sided colorectal cancer between 2004 and 2011 in five tertiary referral hospitals were analyzed. Long-term survivals were analyzed and adjusted using the inverse probability of treatment weighting method, based on propensity scores, to reduce selection bias. RESULTS: One hundred and nine patients underwent immediate surgery, and 226 underwent stent insertion before surgery. Disease-free survival did not differ significantly in both the unadjusted population (hazard ratio [HR] 1.063, 95% confidence interval [CI] 0.730-1.548; Log-rank, p = 0.746) and the adjusted population (HR 0.122, 95% CI 0.920-1.987; Log-rank, p = 0.122). Overall survival also did not differ significantly in both the unadjusted population (HR 0.871, 95% CI 0.568-1.334; Log-rank, p = 0.526) and the adjusted population (HR 1.023, 95% CI 0.665-1.572; Log-rank, p = 0.916). Defunctioning stoma formation was less in the SEMS insertion group than immediate surgery group (adjusted, 14.6% vs. 41.3%, p < 0.001). CONCLUSION: The 'bridge to surgery' strategy using metallic stents was oncologically comparable to immediate surgery in patients with malignant left-sided colorectal obstruction.
BACKGROUND: Colonic self-expanding metallic stenting (SEMS) is widely used for the treatment of malignant colonic obstruction as a bridge to elective surgery. However, the effects of colonic stenting on long-term oncologic outcomes are debatable. This study aimed to compare the long-term oncologic outcomes of preoperative SEMS insertion with those of immediate surgery in patients with obstructing left-sided colorectal cancer. METHODS: A cohort of consecutive patients who underwent radical surgery for obstructing left-sided colorectal cancer between 2004 and 2011 in five tertiary referral hospitals were analyzed. Long-term survivals were analyzed and adjusted using the inverse probability of treatment weighting method, based on propensity scores, to reduce selection bias. RESULTS: One hundred and nine patients underwent immediate surgery, and 226 underwent stent insertion before surgery. Disease-free survival did not differ significantly in both the unadjusted population (hazard ratio [HR] 1.063, 95% confidence interval [CI] 0.730-1.548; Log-rank, p = 0.746) and the adjusted population (HR 0.122, 95% CI 0.920-1.987; Log-rank, p = 0.122). Overall survival also did not differ significantly in both the unadjusted population (HR 0.871, 95% CI 0.568-1.334; Log-rank, p = 0.526) and the adjusted population (HR 1.023, 95% CI 0.665-1.572; Log-rank, p = 0.916). Defunctioning stoma formation was less in the SEMS insertion group than immediate surgery group (adjusted, 14.6% vs. 41.3%, p < 0.001). CONCLUSION: The 'bridge to surgery' strategy using metallic stents was oncologically comparable to immediate surgery in patients with malignant left-sided colorectal obstruction.