Oncologic outcomes of preoperative stent insertion first versus immediate surgery for obstructing left-sided colorectal cancer.
Surg Oncol
; 27(2): 216-224, 2018 Jun.
Article
em En
| MEDLINE
| ID: mdl-29937174
ABSTRACT
BACKGROUND:
Colonic self-expanding metallic stenting (SEMS) is widely used for the treatment of malignant colonic obstruction as a bridge to elective surgery. However, the effects of colonic stenting on long-term oncologic outcomes are debatable. This study aimed to compare the long-term oncologic outcomes of preoperative SEMS insertion with those of immediate surgery in patients with obstructing left-sided colorectal cancer.METHODS:
A cohort of consecutive patients who underwent radical surgery for obstructing left-sided colorectal cancer between 2004 and 2011 in five tertiary referral hospitals were analyzed. Long-term survivals were analyzed and adjusted using the inverse probability of treatment weighting method, based on propensity scores, to reduce selection bias.RESULTS:
One hundred and nine patients underwent immediate surgery, and 226 underwent stent insertion before surgery. Disease-free survival did not differ significantly in both the unadjusted population (hazard ratio [HR] 1.063, 95% confidence interval [CI] 0.730-1.548; Log-rank, pâ¯=â¯0.746) and the adjusted population (HR 0.122, 95% CI 0.920-1.987; Log-rank, pâ¯=â¯0.122). Overall survival also did not differ significantly in both the unadjusted population (HR 0.871, 95% CI 0.568-1.334; Log-rank, pâ¯=â¯0.526) and the adjusted population (HR 1.023, 95% CI 0.665-1.572; Log-rank, pâ¯=â¯0.916). Defunctioning stoma formation was less in the SEMS insertion group than immediate surgery group (adjusted, 14.6% vs. 41.3%, pâ¯<â¯0.001).CONCLUSION:
The 'bridge to surgery' strategy using metallic stents was oncologically comparable to immediate surgery in patients with malignant left-sided colorectal obstruction.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Complicações Pós-Operatórias
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Neoplasias Colorretais
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Stents
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Procedimentos Cirúrgicos Eletivos
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Obstrução Intestinal
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article