Early surgery after bridge-to-surgery stenting for malignant bowel obstruction is associated with better oncological outcomes
| Autor: | Clyve Yu Leon Yaow, Ian Jse-Wei Tan, Kuok Chung Lee, Hui Yu Tham, Tammy Lim, Bettina Lieske, Ker-Kan Tan, Choon Seng Chong, Ridzuan Farouk, Dedrick Kok Hong Chan |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Colon medicine.medical_treatment 03 medical and health sciences 0302 clinical medicine Self-expandable metallic stent medicine Humans Elective surgery Prospective cohort study Retrospective Studies Univariate analysis business.industry Stent Surgical Stomas Retrospective cohort study medicine.disease Surgery Bowel obstruction Treatment Outcome 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology Stents business Colorectal Neoplasms Intestinal Obstruction Abdominal surgery |
| Zdroj: | Surgical endoscopy. 35(12) |
| ISSN: | 1432-2218 |
| Popis: | Placement of self-expanding metal stents has been increasingly adopted as a bridge to surgery in patients presenting with obstructed left-sided colorectal cancers. The optimal bridging time has yet to be widely established, hence this retrospective study aims to determine the optimal bridging time to elective surgery post endoluminal stenting. All patients who underwent colorectal stenting for large bowel obstruction in a single, tertiary hospital in Singapore between January 2003 and December 2017 were retrospectively identified. Patients’ baseline demographics, tumour characteristics, stent-related complications, intra-operative details, post-operative complications and oncological outcomes were analysed. Of the 53 patients who successfully underwent colonic stenting for malignant left sided obstruction, 33.96% of patients underwent surgery within two weeks of stent placement while 66.04% of patients underwent surgery after 2 weeks of stent placement. Univariate analysis between both groups did not demonstrate significant differences in postoperative complications and stoma formation. Significant differences were observed between both groups for stent complications (38.89% vs 8.57%, p = 0.022), on-table decompression (38.89% vs 2.86%, p = 0.001) and systemic recurrence (11.11% vs 40.00%, p = 0.030). Increased bridging interval to surgery (OR 13.16, CI 1.37–126.96, p = 0.026) was a significant risk factor for systemic recurrence on multivariate analysis. Patients undergoing definitive surgery within 2 weeks of colonic stenting may have better oncological outcomes without compromising on postoperative outcomes. Further prospective studies are required to compare outcomes between emergency surgery and different bridging intervals. |
| Databáze: | OpenAIRE |
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