Eduardo Rodrigues-Pinto1, Rui Morais2, Catarina Coelho3, Pedro Pereira2, Alessandro Repici4, Guilherme Macedo2. 1. Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal. Electronic address: edu.gil.pinto@gmail.com. 2. Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal. 3. Gastroenterology Department, Faculty of Medicine, University of Porto, Porto, Portugal. 4. Gastroenterology, Humanitas Research Hospital & Humanitas University, Milan, Italy.
Abstract
OBJECTIVE: Compare efficacy, safety and long-term outcomes of bridge-to-surgery and emergency surgery in acute malignant colorectal obstruction. METHODS: Retrospective study of 94 consecutive patients with left-sided acute malignant colorectal obstruction treated with curative intent between 2010-2017. RESULTS: 48 patients underwent stent placement and 46 underwent emergency surgery. Technical and clinical success were 100% and 87%. Laparoscopy and one-staged operation were more frequent in bridge-to-surgery (44% vs 2%, p < 0.001; 73% vs 30%, p < 0.001). Fewer permanent stomas were created in bridge-to-surgery (15% vs 35%, p = 0.013). Overall morbidity was 36%. Immediate and post-procedure stent related-complications occurred in 6% and 13%; surgery-related complications occurred in 28% (bridge-to-surgery: 15% vs emergency surgery: 41%, p = 0.004). No differences were found regarding tumor recurrence, recurrence-free survival and overall survival. R1 resection (HR 47.2, 95%CI:4.1-543.7), number of lymph nodes harvested (HR 0.9 95%CI:0.8-0.99) and adjuvant therapy (HR 0.1 95%CI:0.01-0.9) predicted recurrence-free survival; pTMN stage IV (HR 7.3, 95%CI:1.1-47.6), number of lymph nodes harvested (HR 0.90, 95%CI:0.8-0.97), adjuvant therapy (HR 0.1, 95%CI:0.02-0.4) and surgery-related complications (HR 5.3, 95%CI:1.02-27.3) influenced overall survival. CONCLUSION: Stent placement has a high success, similarly to emergency surgery, being associated with higher primary anastomosis and lower stoma rates. Tumor recurrence rate, recurrence-free survival and overall survival were comparable between groups; surgery-related complications influenced overall survival.
OBJECTIVE: Compare efficacy, safety and long-term outcomes of bridge-to-surgery and emergency surgery in acute malignant colorectal obstruction. METHODS: Retrospective study of 94 consecutive patients with left-sided acute malignant colorectal obstruction treated with curative intent between 2010-2017. RESULTS: 48 patients underwent stent placement and 46 underwent emergency surgery. Technical and clinical success were 100% and 87%. Laparoscopy and one-staged operation were more frequent in bridge-to-surgery (44% vs 2%, p < 0.001; 73% vs 30%, p < 0.001). Fewer permanent stomas were created in bridge-to-surgery (15% vs 35%, p = 0.013). Overall morbidity was 36%. Immediate and post-procedure stent related-complications occurred in 6% and 13%; surgery-related complications occurred in 28% (bridge-to-surgery: 15% vs emergency surgery: 41%, p = 0.004). No differences were found regarding tumor recurrence, recurrence-free survival and overall survival. R1 resection (HR 47.2, 95%CI:4.1-543.7), number of lymph nodes harvested (HR 0.9 95%CI:0.8-0.99) and adjuvant therapy (HR 0.1 95%CI:0.01-0.9) predicted recurrence-free survival; pTMN stage IV (HR 7.3, 95%CI:1.1-47.6), number of lymph nodes harvested (HR 0.90, 95%CI:0.8-0.97), adjuvant therapy (HR 0.1, 95%CI:0.02-0.4) and surgery-related complications (HR 5.3, 95%CI:1.02-27.3) influenced overall survival. CONCLUSION: Stent placement has a high success, similarly to emergency surgery, being associated with higher primary anastomosis and lower stoma rates. Tumor recurrence rate, recurrence-free survival and overall survival were comparable between groups; surgery-related complications influenced overall survival.
Authors: Jian Lv; Yuan Yuan Liu; Yi Tao Jia; Jing Li He; Guang Yao Dai; Peng Guo; Zhao Long Zhao; Yan Ni Zhang; Zhong Xin Li Journal: World J Surg Oncol Date: 2021-12-02 Impact factor: 2.754
Authors: Roberto Cirocchi; Alberto Arezzo; Paolo Sapienza; Daniele Crocetti; Davide Cavaliere; Leonardo Solaini; Giorgio Ercolani; Antonio V Sterpetti; Andrea Mingoli; Enrico Fiori Journal: Medicina (Kaunas) Date: 2021-03-15 Impact factor: 2.430