Carmen Lara-Romero1,2, Ángel Vilches3, Ángel Caunedo-Álvarez4, Pedro Hergueta-Delgado4, Isabel Lavín-Castejón5, Raúl Andrade-Bellido5, Guillermo Alcaín-Martínez5. 1. Department of Digestive Diseases, Virgen de la Victoria University Hospital, Málaga, Spain. carmenlararomero@gmail.com. 2. Department of Digestive Diseases, Virgen Macarena University Hospital, Seville, Spain. carmenlararomero@gmail.com. 3. Department of Epidemiology and Statistics, Seville University, Seville, Spain. 4. Department of Digestive Diseases, Virgen Macarena University Hospital, Seville, Spain. 5. Department of Digestive Diseases, Virgen de la Victoria University Hospital, Málaga, Spain.
Abstract
PURPOSE: Stenting as a bridge to surgery (SBTS) can transform an emergency surgery (ES) into an elective surgery in patients with symptomatic left-sided malignant colonic obstruction. Concerns have been raised regarding short-term morbidity and long-term oncologic outcomes, with contrasting results reported in the literature. Our main aim is to evaluate not only long-term oncologic outcomes but also short-term postoperative outcomes of stented patients who underwent elective surgery compared to those who had ES. METHODS: From January 2006 to May 2012, we retrospectively identified patients with confirmed left-sided colorectal cancer obstruction. This was done in two centers of reference of colorectal diseases in southern Spain with patients who were treated with curative intent either with ES or SBTS. The short- and long-term results were compared between both groups. RESULTS: There were 71 patients in the stenting group and 66 in the emergency surgery group, with similar demographic data. Initial stoma creation rates were lower in the SBTS group (16.9% vs. 54.5%, p < 0.005) and the primary anastomosis rate was higher in the same group (83.1% vs. 45.5%, p < 0.005). Five-year recurrence-free survival (RFS) rates were comparable between groups (75.3 vs. 59.8%, p = 0.220), but RFS rates at 5 years for AJCC pathologic stage III were higher in the stenting group (69.7% vs 30%, p = 0.004). Both groups were comparable regarding overall and cancer-specific survival outcomes. CONCLUSIONS: The use of SBTS reduces ostomy rates in patients with obstructive colon malignancies. Long-term survival results are similar. Patients in the SBTS group with stage III AJCC status showed a higher 5-year recurrence-free survival rate than those in the ES group.
PURPOSE: Stenting as a bridge to surgery (SBTS) can transform an emergency surgery (ES) into an elective surgery in patients with symptomatic left-sided malignant colonic obstruction. Concerns have been raised regarding short-term morbidity and long-term oncologic outcomes, with contrasting results reported in the literature. Our main aim is to evaluate not only long-term oncologic outcomes but also short-term postoperative outcomes of stented patients who underwent elective surgery compared to those who had ES. METHODS: From January 2006 to May 2012, we retrospectively identified patients with confirmed left-sided colorectal cancer obstruction. This was done in two centers of reference of colorectal diseases in southern Spain with patients who were treated with curative intent either with ES or SBTS. The short- and long-term results were compared between both groups. RESULTS: There were 71 patients in the stenting group and 66 in the emergency surgery group, with similar demographic data. Initial stoma creation rates were lower in the SBTS group (16.9% vs. 54.5%, p < 0.005) and the primary anastomosis rate was higher in the same group (83.1% vs. 45.5%, p < 0.005). Five-year recurrence-free survival (RFS) rates were comparable between groups (75.3 vs. 59.8%, p = 0.220), but RFS rates at 5 years for AJCC pathologic stage III were higher in the stenting group (69.7% vs 30%, p = 0.004). Both groups were comparable regarding overall and cancer-specific survival outcomes. CONCLUSIONS: The use of SBTS reduces ostomy rates in patients with obstructive colon malignancies. Long-term survival results are similar. Patients in the SBTS group with stage III AJCC status showed a higher 5-year recurrence-free survival rate than those in the ES group.
Entities:
Keywords:
Bridge to surgery; Colonic stenting; Malignant left-sided colonic obstruction
Authors: Carlos Bustamante Recuenco; Javier García Septiem; Javier Arias Díaz; Israel John Thuissard Vasallo; Alejandro Andonaegui de la Madriz; Virginia Jiménez Carneros; Jose Luis Ramos Rodríguez; José María Jover Navalón; Francisco Javier Jiménez Miramón Journal: Int J Colorectal Dis Date: 2022-01-23 Impact factor: 2.571