Time interval between self-expandable metal stent placement or creation of a decompressing stoma and elective resection of left-sided obstructive colon cancer.

Autor:	Veld JV; Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.; Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, The Netherlands., Kumcu A; Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, The Netherlands., Amelung FJ; Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands., Borstlap WAA; Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands., Consten ECJ; Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands.; Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands., Dekker JWT; Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands., van Westreenen HL; Department of Surgery, Isala Zwolle, Zwolle, The Netherlands., Siersema PD; Department of Gastroenterology and Hepatology, Radboud Academic Medical Center, Nijmegen, The Netherlands., Ter Borg F; Department of Gastroenterology and Hepatology, Deventer Hospital, Deventer, The Netherlands., Kusters M; Department of Surgery, Amsterdam UMC, Vrije Universiteit, Cancer Center Amsterdam, Amsterdam, The Netherlands., Bemelman WA; Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands., de Wilt JHW; Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands., van Hooft JE; Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, The Netherlands.; Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands., Tanis PJ; Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.
Jazyk:	angličtina
Zdroj:	Endoscopy [Endoscopy] 2021 Sep; Vol. 53 (9), pp. 905-913. Date of Electronic Publication: 2020 Dec 18.
DOI:	10.1055/a-1308-1487
Abstrakt:	Background: The optimal timing of resection after decompression of left-sided obstructive colon cancer is unknown. Revised expert-based guideline recommendations have shifted from an interval of 5 - 10 days to approximately 2 weeks following self-expandable metal stent (SEMS) placement, and recommendations after decompressing stoma are lacking. We aimed to evaluate the recommended bridging intervals after SEMS and explore the timing of resection after decompressing stoma. Methods: This nationwide study included patients registered between 2009 and 2016 in the prospective, mandatory Dutch ColoRectal Audit. Additional data were collected through patient records in 75 hospitals. Only patients who underwent either SEMS placement or decompressing stoma as a bridge to surgery were selected. Technical SEMS failure and unsuccessful decompression within 48 hours were exclusion criteria. Results: 510 patients were included (182 SEMS, 328 decompressing stoma). Median bridging interval was 23 days (interquartile range [IQR] 13 - 31) for SEMS and 36 days (IQR 22 - 65) for decompressing stoma. Following SEMS placement, no significant differences in post-resection complications, hospital stay, or laparoscopic resections were observed with resection after 11 - 17 days compared with 5 - 10 days. Of SEMS-related complications, 48 % occurred in patients operated on beyond 17 days. Compared with resection within 14 days, an interval of 14 - 28 days following decompressing stoma resulted in significantly more laparoscopic resections, more primary anastomoses, and shorter hospital stays. No impact of bridging interval on mortality, disease-free survival, or overall survival was demonstrated. Conclusions: Based on an overview of the data with balancing of surgical outcomes and timing of adverse events, a bridging interval of approximately 2 weeks seems appropriate after SEMS placement, while waiting 2 - 4 weeks after decompressing stoma further optimizes surgical conditions for laparoscopic resection with restoration of bowel continuity. Competing Interests: Outside of the submitted work, J.E. van Hooft received a grant from Cook Medicals and a consultancy fee from Boston Scientific and Medtronics; P.D. Siersema receives grant support from Pentax Medical, Norgine, EndoStim, and Motus GI, and is on the advisory board of Pentax, Ella-CS, and Boston Scientific. The authors declare that they have no conflict of interest. (Thieme. All rights reserved.)
Databáze:	MEDLINE
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