Is Stenting as 'a Bridge to Surgery' an Oncologically Safe Strategy for the Management of Acute, Left-Sided, Malignant, Colonic Obstruction? A Comparative Study With a Propensity Score Analysis
| Autor: | Cyril Cosse, Jean-Marc Regimbeau, Eric Bartoli, François Mauvais, Bruno Chauffert, François Browet, Olivier Brehant, Eric Nguyen-Khac, Jean-Louis Dupas, Charles Sabbagh, Momar Diouf |
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| Rok vydání: | 2013 |
| Předmět: |
Male
medicine.medical_specialty Endpoint Determination medicine.medical_treatment Adenocarcinoma Left sided Statistics Nonparametric Humans Medicine Bridge to surgery Propensity Score Survival rate Aged Proportional Hazards Models Retrospective Studies Chi-Square Distribution business.industry Stent Retrospective cohort study Surgery Survival Rate Colonic obstruction Treatment Outcome Colonic Neoplasms Propensity score matching Female Stents business Chi-squared distribution Intestinal Obstruction |
| Zdroj: | Annals of Surgery. 258:107-115 |
| ISSN: | 0003-4932 |
| DOI: | 10.1097/sla.0b013e31827e30ce |
| Popis: | Self-expanding metallic stent (SEMS) insertion has been suggested as a promising alternative to emergency surgery for left-sided malignant colonic obstruction (LMCO). However, the literature on the long-term impact of SEMS as "a bridge to surgery" is limited and contradictory.From January 1998 to June 2011, we retrospectively identified patients operated on for LMCO with curative intent. The primary outcome criterion was overall survival. Short-term secondary endpoints included the technical success rate and overall success rate and long-term secondary endpoints included 5-year overall survival, 5-year cancer-specific mortality, 5-year disease-free survival, the recurrence rate, and mean time to recurrence. Patients treated with SEMS were analyzed on an intention-to-treat basis. Overall survival was analyzed after using a propensity score to correct for selection bias.There were 48 patients in the SEMS group and 39 in the surgery-only group. In the overall population, overall survival (P = 0.001) and 5-year overall survival (P = 0.0003) were significantly lower in the SEMS group than in the surgery-only group, and 5-year cancer-specific mortality was significantly higher in the SEMS group (48% vs 21%, respectively (P = 0.02)). Five-year disease-free survival, the recurrence rate, and the mean time to recurrence were better in the surgery-only group (not significant). For patients with no metastases or perforations at hospital admission, overall survival (P = 0.003) and 5-year overall survival (30% vs 67%, respectively, P = 0.001) were significantly lower in the SEMS group than in the surgery-only group.Our study results suggest worse overall survival of patients with LMCO with SEMS insertion compared with immediate surgery. |
| Databáze: | OpenAIRE |
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