Upfront surgery versus self-expanding metallic stent as bridge to surgery in left-sided colonic cancer obstruction: A multicenter observational study

被引：8

作者：

Hidalgo-Pujol, Marta ^{[1
,2
,23
]}

Biondo, Sebastiano ^{[1
,2
]}

Trill, Javier Die ^{[3
]}

Vigorita, Vincenzo ^{[4
,5
]}

Garcia-Senorans, Marta Paniagua ^{[5
]}

Miguelanez, Isabel Pascual ^{[6
]}

Noire, Fernando Prieto-La ^{[6
]}

Timoteo, Ander ^{[7
]}

Cornejo, Lidia ^{[8
]}

Parra, Jose Igancio Martin ^{[9
]}

Garcia, Maria Fidalgo ^{[10
]}

Solis-Pena, Alejandro ^{[11
]}

de Tudela, Arturo Cirera ^{[12
]}

Gonzalez, Araceli Rodriguez ^{[13
]}

Sanchez-Guillen, Luis ^{[14
]}

Recuenco, Carlos Bustamante ^{[15
]}

Perez-Alonso, Carla ^{[16
]}

Caballero, Elena Hurtado ^{[17
]}

Pascual, Marta ^{[18
]}

Septiem, Javier Garcia ^{[19
]}

Lopez, Laura Mora ^{[20
]}

Cervera-Aldama, Jorge ^{[21
]}

Gudalajara, Hecttor ^{[22
]}

Espin, Eloy ^{[11
]}

Kreisler, Esther ^{[1
,2
]}

机构：

[1] Bellvitge Univ Hosp, Dept Gen & Digest Surg, Coloproctol Unit, Barcelona, Spain

[2] Univ Barcelona, Barcelona, Spain

[3] Ramon & Cajal Univ Hosp, Dept Gen & Digest Surg, Coloproctol Unit, Madrid, Spain

[4] Univ Hosp Complex Vigo, Dept Gen & Digest Surg, Div Coloproctol, Vigo, Spain

[5] Galicia Sur Hlth Res Inst IIS Galicia Sur, Gen Surg Res Grp, SERGAS UVIGO, Vigo, Spain

[6] La Paz Univ Hosp, Dept Gen & Digest Surg, Madrid, Spain

[7] Doctor Josep Trueta Univ Hosp, Dept Gen & Digest Surg, Girona, Spain

[8] Girona Biomed Res Inst IDIBGI, Gen & digest Surg Res Grp, Girona, Spain

[9] Marques Valdecilla Univ Hosp, Dept Gen & Digest Surg, Div Coloproctol, Santander, Spain

[10] Marques Valdecilla Univ Hosp, Dept Gen & Digest Surg, Santander, Spain

[11] Auton Univ Barcelona, Vall Hebron Univ Hosp, Dept Gen & Digest Surg, Coloproctol Unit, Barcelona, Spain

[12] Vall Hebron Univ Hosp, Dept Gen & Digest Surg, Barcelona, Spain

[13] Donostia Univ Hosp, Dept Gen & Digest Surg, Emergency Surg Unit, San Sebastian, Spain

[14] Elche Univ Hosp, Dept Gen & Digest Surg, Coloproctol Unit, Alicante, Spain

[15] Nuestra Senora Prado Hosp, Dept Gen & Digest Surg, Talavera De La Reina, Toledo, Spain

[16] La Fe Univ Hosp, Dept Gen & Digest Surg, Valencia, Spain

[17] Gregorio Maranon Univ Hosp, Dept Gen & Digest Surg, Coloproctol Unit, Madrid, Spain

[18] Hosp del Mar, Dept Gen & Digest Surg, Coloproctol Unit, Barcelona, Spain

[19] La Princesa Univ Hosp, Dept Gen & Digest Surg, Madrid, Spain

[20] Parc Tauli Univ Hosp, Dept Gen & Digest Surg, Sabadell, Spain

[21] Cruces Univ Hosp Barakaldo, Gen & Digest Surg Dept, Coloproctol Unit, Bizkaia, Spain

[22] Fdn Jimenez Diaz Univ Hosp, Dept Gen & Digest Surg, Madrid, Spain

[23] 146Gran Via Hosp,Hosp Llobregat, Barcelona 08907, Spain

来源：

SURGERY | 2022年 / 172卷 / 01期

关键词：

CLINICAL-PRACTICE GUIDELINES; CONVENTIONAL OPEN SURGERY; LARGE-BOWEL OBSTRUCTION; EMERGENCY-SURGERY; LAPAROSCOPIC APPROACH; ONCOLOGIC OUTCOMES; MANAGEMENT; COMPLICATIONS; RESECTION; SURVIVAL;

D O I：

10.1016/j.surg.2021.12.035

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Background: Oncological outcomes of self-expanding metallic stent used as a bridge to surgery in potential curative patients with left-sided colonic cancer obstruction remain unclear. The aim of this study was to investigate perioperative and mid-term oncological outcomes of 2 of the currently most commonly performed treatments in left-sided colonic cancer obstruction.Methods: This is a retrospective multicenter study including patients with left-sided colonic cancer obstruction treated with curative intent between 2013 and 2017. The presence of metastasis at diagnosis was an exclusion criterion. The primary outcome was to evaluate the noninferiority, in terms of overall survival, of bridge to surgery strategy compared with emergency colonic resection. The secondary outcomes were perioperative morbimortality, disease free survival, local recurrence, and distant recurrence.Results: A total of 564 patients were included, 320 in the emergency colonic resection group and 244 in the bridge to surgery group. Twenty-seven patients of the bridge-to-surgery group needed urgent operation. Postoperative morbidity rates were statistically higher in the emergency colonic resection group (odds ratio [95% confidence interval] 0.37 [0.24-0.55], P < .001). There was no difference in 90-day mortality between groups (odds ratio [95% confidence interval] 0.85 [0.36-1.99], P = .702). The median follow-up was 3.80 years (2.29-4.92). The results show the noninferiority of bridge to surgery versus emergency colonic resection in terms of overall survival (hazard ratio [95% confidence interval) 0.78 [0.56-1.07], P = .127). There were no differences in disease free survival, distant recurrence, and local recurrence rates between bridge to surgery and emergency colonic resection groups.Conclusion: Self-expanding metallic stent as bridge to surgery might not lead to a negative impact on the long-term prognosis of the tumor compared with emergency colonic resection in expert hands and selected patients. (c) 2022 Elsevier Inc. All rights reserved.

引用

页码：74 / 82

页数：9

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