F J Amelung1, W A A Borstlap2, E C J Consten1, J V Veld2, E E van Halsema3, W A Bemelman2, P D Siersema4, F Ter Borg5, J E van Hooft3, P J Tanis2. 1. Department of Surgery, Meander Medical Centre, Amersfoort, the Netherlands. 2. Department of Surgery, Amsterdam University Medical Centres, location AMC, Amsterdam, the Netherlands. 3. Department of Gastroenterology and Hepatology, Amsterdam University Medical Centres, location AMC, Amsterdam, the Netherlands. 4. Department of Gastroenterology and Hepatology, Radboud Academic Medical Centre, Nijmegen, the Netherlands. 5. Department of Gastroenterology and Hepatology, Deventer Hospital, Deventer, the Netherlands.
Abstract
BACKGROUND: Although self-expandable metal stent (SEMS) placement as bridge to surgery (BTS) in patients with left-sided obstructing colonic cancer has shown promising short-term results, it is used infrequently owing to uncertainty about its oncological safety. This population study compared long-term oncological outcomes between emergency resection and SEMS placement as BTS. METHODS: Through a national collaborative research project, long-term outcome data were collected for all patients who underwent resection for left-sided obstructing colonic cancer between 2009 and 2016 in 75 Dutch hospitals. Patients were identified from the Dutch Colorectal Audit database. SEMS as BTS was compared with emergency resection in the curative setting after 1 : 2 propensity score matching. RESULTS: Some 222 patients who had a stent placed were matched to 444 who underwent emergency resection. The overall SEMS-related perforation rate was 7·7 per cent (17 of 222). Three-year locoregional recurrence rates after SEMS insertion and emergency resection were 11·4 and 13·6 per cent (P = 0·457), disease-free survival rates were 58·8 and 52·6 per cent (P = 0·175), and overall survival rates were 74·0 and 68·3 per cent (P = 0·231), respectively. SEMS placement resulted in significantly fewer permanent stomas (23·9 versus 45·3 per cent; P < 0·001), especially in elderly patients (29·0 versus 57·9 per cent; P < 0·001). For patients in the SEMS group with or without perforation, 3-year locoregional recurrence rates were 18 and 11·0 per cent (P = 0·432), disease-free survival rates were 49 and 59·6 per cent (P = 0·717), and overall survival rates 61 and 75·1 per cent (P = 0·529), respectively. CONCLUSION: Overall, SEMS as BTS seems an oncologically safe alternative to emergency resection with fewer permanent stomas. Nevertheless, the risk of SEMS-related perforation, as well as permanent stoma, might influence shared decision-making for individual patients.
BACKGROUND: Although self-expandable metal stent (SEMS) placement as bridge to surgery (BTS) in patients with left-sided obstructing colonic cancer has shown promising short-term results, it is used infrequently owing to uncertainty about its oncological safety. This population study compared long-term oncological outcomes between emergency resection and SEMS placement as BTS. METHODS: Through a national collaborative research project, long-term outcome data were collected for all patients who underwent resection for left-sided obstructing colonic cancer between 2009 and 2016 in 75 Dutch hospitals. Patients were identified from the Dutch Colorectal Audit database. SEMS as BTS was compared with emergency resection in the curative setting after 1 : 2 propensity score matching. RESULTS: Some 222 patients who had a stent placed were matched to 444 who underwent emergency resection. The overall SEMS-related perforation rate was 7·7 per cent (17 of 222). Three-year locoregional recurrence rates after SEMS insertion and emergency resection were 11·4 and 13·6 per cent (P = 0·457), disease-free survival rates were 58·8 and 52·6 per cent (P = 0·175), and overall survival rates were 74·0 and 68·3 per cent (P = 0·231), respectively. SEMS placement resulted in significantly fewer permanent stomas (23·9 versus 45·3 per cent; P < 0·001), especially in elderly patients (29·0 versus 57·9 per cent; P < 0·001). For patients in the SEMS group with or without perforation, 3-year locoregional recurrence rates were 18 and 11·0 per cent (P = 0·432), disease-free survival rates were 49 and 59·6 per cent (P = 0·717), and overall survival rates 61 and 75·1 per cent (P = 0·529), respectively. CONCLUSION: Overall, SEMS as BTS seems an oncologically safe alternative to emergency resection with fewer permanent stomas. Nevertheless, the risk of SEMS-related perforation, as well as permanent stoma, might influence shared decision-making for individual patients.
Authors: Joyce V Veld; Femke J Amelung; Wernard A A Borstlap; Emo E van Halsema; Esther C J Consten; Peter D Siersema; Frank Ter Borg; Edwin S van der Zaag; Johannes H W de Wilt; Paul Fockens; Wilhelmus A Bemelman; Jeanin E van Hooft; Pieter J Tanis Journal: JAMA Surg Date: 2020-03-01 Impact factor: 14.766
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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: Vivian P Bastiaenen; Bartholomeus Jga Corten; Elise Aj de Savornin Lohman; Joske de Jonge; Anne C Kraima; Hilko A Swank; Jaap Lp van Vliet; Gijs Jd van Acker; Anna Aw van Geloven; Klaas H In 't Hof; Lianne Koens; Philip R de Reuver; Charles C van Rossem; Gerrit D Slooter; Pieter J Tanis; Valeska Terpstra; Marcel Gw Dijkgraaf; Willem A Bemelman Journal: BMJ Open Date: 2019-12-23 Impact factor: 2.692