Propensity score-matched analysis of oncological outcome between stent as bridge to surgery and emergency resection in patients with malignant left-sided colonic obstruction

被引：77

作者：

Amelung, F. J. ^{[1
]}

Borstlap, W. A. A. ^{[2
]}

Consten, E. C. J. ^{[1
]}

Veld, J. V. ^{[2
]}

van Halsema, E. E. ^{[3
]}

Bemelman, W. A. ^{[2
]}

Siersema, P. D. ^{[4
]}

ter Borg, E. ^{[5
]}

van Hooft, J. E. ^{[3
]}

Tanis, P. J. ^{[2
]}

Algera, H. ^{[6
]}

Algie, G. D. ^{[7
]}

Andeweg, C. S. ^{[8
]}

Argillander, T. ^{[9
]}

Arron, M. N. N. J. ^{[10
]}

Arts, K. ^{[11
]}

Aufenacker, T. H. J. ^{[12
]}

Bakker, I. S. ^{[13
]}

Batenburg, M. van Basten ^{[14
]}

Bastiaansen, A. J. N. M. ^{[15
]}

Beets, G. L. ^{[16
]}

van den Berg, A. ^{[17
]}

van de Beukel, B. ^{[18
]}

Blom, R. L. G. M. ^{[19
]}

Blomberg, B. ^{[20
]}

Boerma, E. G. ^{[21
]}

den Boer, F. C. ^{[22
]}

Bouvy, N. D. ^{[23
]}

Bouwman, J. E. ^{[24
]}

Boye, N. D. A. ^{[25
]}

Brandsma, H. T. ^{[26
]}

Brandt, A. R. M. ^{[27
]}

Breijer, A. ^{[28
]}

van den Broek, W. ^{[29
]}

Broker, M. E. E. ^{[30
]}

Bruns, E. R. J. ^{[31
]}

Burbach, J. P. M. ^{[32
]}

Burghgraef, T. A. ^{[33
]}

Crolla, R. M. P. H. ^{[34
]}

Dam, M. ^{[35
]}

Daniels, L. ^{[36
]}

Dekker, J. W. T. ^{[37
]}

Demirkiran, A. ^{[38
]}

van Dongen, K. ^{[39
]}

Durmaz, S. F. ^{[40
]}

van Esch, A. ^{[41
]}

van Essen, J. A. ^{[42
]}

Foppen, J. W. ^{[43
]}

Furnee, E. J. B. ^{[44
]}

van Geloven, A. A. W. ^{[45
]}

机构：

[1] Meander Med Ctr, Dept Surg, Amersfoort, Netherlands

[2] Univ Amsterdam, Med Ctr, Dept Surg, Locat AMC, Amsterdam, Netherlands

[3] Univ Amsterdam, Med Ctr, Dept Gastroenterol & Hepatol, Locat AMC, Amsterdam, Netherlands

[4] Radboud Acad Med Ctr, Dept Gastroenterol & Hepatol, Nijmegen, Netherlands

[5] Deventer Hosp, Dept Gastroenterol & Hepatol, Deventer, Netherlands

[6] Jeroen Bosch Hosp, Den Bosch, Netherlands

[7] Med Ctr Zuiderzee, Lelystad, Netherlands

[8] St Jansdal Hosp, Harderwijk, Netherlands

[9] Gelre Hosp, Apeldoorn, Netherlands

[10] Radboud Univ Nijmegen, Med Ctr, Nijmegen, Netherlands

[11] Maxima Med Ctr, Eindhoven, Netherlands

[12] Rijnstate Hosp, Arnhem, Netherlands

[13] Treant Hosp, Hoogeveen, Netherlands

[14] Rijnstate Hosp, Arnhem, Netherlands

[15] Haga Hosp, The Hague, Netherlands

[16] Antoni van Leeuwenhoek Hosp, Amsterdam, Netherlands

[17] Rivierenland Hosp, Tiel, Netherlands

[18] Canisius Wilhelmina Hosp, Nijmegen, Netherlands

[19] Onze Lieve Vrouwen Hosp, Amsterdam, Netherlands

[20] Ter Gooi Hosp, Hilversum, Netherlands

[21] Zuyderland Med Ctr, Sittard, Netherlands

[22] Zaans Med Ctr, Zaandam, Netherlands

[23] Maastrisch Univ, Med Ctr, Maastricht, Netherlands

[24] Wilhelmina Gasthuis, Assen, Netherlands

[25] Leids Univ, Med Ctr, Leiden, Netherlands

[26] Vrije Univ Amsterdam Med Ctr, Amsterdam, Netherlands

[27] Erasmus MC, Rotterdam, Netherlands

[28] Van Weel Bethesda Hosp, Dirksland, Netherlands

[29] St Anna Hosp, Geldrop, Netherlands

[30] Erasmus MC, Rotterdam, Netherlands

[31] Gelre Hosp, Apeldoorn, Netherlands

[32] Univ Med Ctr Groningen, Groningen, Netherlands

[33] Meander Med Ctr, Amersfoort, Netherlands

[34] Amphia Hosp, Breda, Netherlands

[35] Elkerliek Hosp, Helmond, Netherlands

[36] Westfries Gasthuis, Hoorn, Netherlands

[37] Reinier de Graaf Hosp, Delft, Netherlands

[38] Rode Kruis Hosp, Beverwijk, Netherlands

[39] Maas Hosp Pantein, Cuijk, Netherlands

[40] Alrijne Hosp, Leiderdorp, Netherlands

[41] Bernhoven Hosp, Uden, Netherlands

[42] St Jan Hosp, Weert, Netherlands

[43] St Jansdal, Harderwijk, Netherlands

[44] Univ Med Ctr Groningen, Groningen, Netherlands

[45] Ter Gooi Hosp, Hilversum, Netherlands

[46] Onze Lieve Vrouwen Gasthuis, Amsterdam, Netherlands

[47] Haga Hosp, The Hague, Netherlands

[48] Univ Med Ctr Utrecht, Utrecht, Netherlands

[49] Haaglanden Hosp, The Hague, Netherlands

[50] Lange Land Hosp, Zoetermeer, Netherlands

来源：

BRITISH JOURNAL OF SURGERY | 2019年 / 106卷 / 08期

关键词：

LARGE-BOWEL OBSTRUCTION; TUMOR-CELL DISSEMINATION; EXPANDABLE METAL STENTS; LONG-TERM OUTCOMES; CANCER; MANAGEMENT; IMPACT; INSERTION; TRIAL;

D O I：

10.1002/bjs.11172

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Background: Although self-expandable metal stent (SEMS) placement as bridge to surgery (BTS) in patients with left-sided obstructing colonic cancer has shown promising short-term results, it is used infrequently owing to uncertainty about its oncological safety. This population study compared long-term oncological outcomes between emergency resection and SEMS placement as BTS. Methods: Through a national collaborative research project, long-term outcome data were collected for all patients who underwent resection for left-sided obstructing colonic cancer between 2009 and 2016 in 75 Dutch hospitals. Patients were identified from the Dutch Colorectal Audit database. SEMS as BTS was compared with emergency resection in the curative setting after 1: 2 propensity score matching. Results: Some 222 patients who had a stent placed were matched to 444 who underwent emergency resection. The overall SEMS-related perforation rate was 7.7 per cent (17 of 222). Three-year locoregional recurrence rates after SEMS insertion and emergency resection were 11-4 and 13.6 per cent (P= 0-457), disease-free survival rates were 58-8 and 52.6 per cent (P= 0-175), and overall survival rates were 74-0 and 68-3 per cent (P= 0.231), respectively. SEMS placement resulted in significantly fewer permanent stomas (23.9 versus 45.3 per cent; P < 0-001), especially in elderly patients (29.0 versus 57.9 per cent; P < 0-001). For patients in the SEMS group with or without perforation, 3-year locoregional recurrence rates were 18 and 11.0 per cent (P= 0.432), disease-free survival rates were 49 and 59.6 per cent (P= 0-717), and overall survival rates 61 and 75.1 per cent (P= 0.529), respectively. Conclusion: Overall, SEMS as BTS seems an oncologically safe alternative to emergency resection with fewer permanent stomas. Nevertheless, the risk of SEMS-related perforation, as well as permanent stoma, might influence shared decision-making for individual patients.

引用

页码：1075 / 1086

页数：12

共 35 条

[31] Colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a multicentre randomised trial [J].