Shunji Morita1, Kansuke Yamamoto2, Atsuhiro Ogawa3, Atsushi Naito4, Hitoshi Mizuno5, Shinichi Yoshioka6, Tae Matsumura7, Katsuya Ohta8, Rei Suzuki9, Chu Matsuda10, Taishi Hata10, Junichi Nishimura11, Tsunekazu Mizushima10, Yuichiro Doki10, Masaki Mori10. 1. Department of Surgery, Toyonaka Municipal Hospital, Shibahara 4-14-1, Toyonaka, Osaka, 560-8565, Japan. shun4morita@gmail.com. 2. Department of Surgery, Bell Land General Hospital, Higashiyama 500-3, Naka-ku, Sakai, Osaka, 599-8247, Japan. 3. Department of Surgery, Tane General Hospital, Kujyominami 1-12-21, Nishi-ku, Osaka, Osaka, 550-0025, Japan. 4. Department of Surgery, Kansai Rosai Hospital, Inabaso 3-1-69, Amagasaki, Hyogo, 660-8511, Japan. 5. Department of Surgery, Nissay Hospital, Itachibori 6-3-8, Nishi-ku, Osaka, Osaka, 550-0012, Japan. 6. Department of Surgery, Nishinomiya Municipal Central Hospital, Hayashida-cyo 8-24, Nishinomiya, Hyogo, 663-8014, Japan. 7. Department of Surgery, Osaka Rosai Hospital, Nakasone-cyo 1179-3, Kita-ku, Sakai, Osaka, 591-8025, Japan. 8. Department of Gastroenterological Surgery, Higashiosaka City Medical Center, Nishiiwata 3-4-5, Higashiosaka, Osaka, 578-8588, Japan. 9. Department of Surgery, Itami City Hospital, Koyaike 1-100, Itami, Hyogo, 664-8540, Japan. 10. Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan. 11. Department of Gastrointestinal Surgery, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan.
Abstract
PURPOSE: To assess the benefit of placing a self-expandable metallic stent (SEMS) as a bridge to surgery for obstructive colorectal cancer (OCRC) according to the tumor site. METHODS: The subjects of this retrospective multicenter cohort study were 201 patients with OCRC, but without initial bowel perforation, who were treated either with a self-expandable metallic stent (SEMS) as a bridge to surgery (n = 109) or with primary surgery (PS; n = 92) between 2014 and 2016. The cohort consisted of 68 patients with right-sided and 133 left-sided OCRC. We evaluated the short-term surgical outcomes for each side. RESULTS: The SEMS group of patients with left-sided OCRC had significantly higher rates of primary resection, primary resection with anastomosis, stoma-free surgery, and laparoscopic surgery than the PS group of patients with left-sided OCRC. In contrast, the SEMS group of patients with right-sided OCRC had only a significantly higher rate of laparoscopic surgery than the PS group of patients with right-sided OCRC, but they had a longer overall hospital stay. There were no significant differences between the two treatment groups in the rates of morbidity or mortality, for either right-sided or left-sided OCRC. CONCLUSION: The benefit of a SEMS as a bridge to surgery may be less for right-sided than for left-sided obstructions in colon cancer patients.
PURPOSE: To assess the benefit of placing a self-expandable metallic stent (SEMS) as a bridge to surgery for obstructive colorectal cancer (OCRC) according to the tumor site. METHODS: The subjects of this retrospective multicenter cohort study were 201 patients with OCRC, but without initial bowel perforation, who were treated either with a self-expandable metallic stent (SEMS) as a bridge to surgery (n = 109) or with primary surgery (PS; n = 92) between 2014 and 2016. The cohort consisted of 68 patients with right-sided and 133 left-sided OCRC. We evaluated the short-term surgical outcomes for each side. RESULTS: The SEMS group of patients with left-sided OCRC had significantly higher rates of primary resection, primary resection with anastomosis, stoma-free surgery, and laparoscopic surgery than the PS group of patients with left-sided OCRC. In contrast, the SEMS group of patients with right-sided OCRC had only a significantly higher rate of laparoscopic surgery than the PS group of patients with right-sided OCRC, but they had a longer overall hospital stay. There were no significant differences between the two treatment groups in the rates of morbidity or mortality, for either right-sided or left-sided OCRC. CONCLUSION: The benefit of a SEMS as a bridge to surgery may be less for right-sided than for left-sided obstructions in colon cancerpatients.
Entities:
Keywords:
Bridge to surgery; Colorectal cancer; Self-expandable metallic stent (SEMS)
Authors: Jeske R E Boeding; Winesh Ramphal; Arjen M Rijken; Rogier M P H Crolla; Cornelis Verhoef; Paul D Gobardhan; Jennifer M J Schreinemakers Journal: Ann Surg Oncol Date: 2020-10-16 Impact factor: 5.344