Impacto de la utilización de stents colónicos como puente a la cirugía de neoplasias colorrectales oclusivas potencialmente curables sobre los resultados quirúrgicos y oncológicos / Impact on surgical and oncological results of the use of colonic stents as a bridge to surgery for potentially curable occlusive colorectal neoplasms

INTRODUCCIÓN: La seguridad y los resultados oncológicos de los pacientes tratados con stents cólicos como puente a la cirugía (PAC) son controvertidos. El objetivo de este estudio es evaluar los efectos sobre los resultados quirúrgicos y oncológicos de los stents como PAC de las neoplasias colorrectales oclusivas potencialmente resecables. MÉTODOS: Análisis retrospectivo de los pacientes intervenidos por neoplasia colorrectal oclusiva potencialmente resecable con o sin enfermedad a distancia entre septiembre de 2002 y octubre de 2015, comparando los pacientes tratados con stent como PAC (grupo Stent) con los intervenidos de forma urgente (grupo Cirugía). RESULTADOS: Veinte pacientes fueron intervenidos directamente, mientras que se intentó la colocación de un stent en 57 pacientes. En el grupo Stent hubo más intervenciones laparoscópicas (64,9 vs. 5%, p < 0,001), más anastomosis primarias (91,2 vs. 55%, p = 0,001), menos estomas (10,5 vs. 50%, p = 0,001) y una estancia postoperatoria más corta (7 vs. 12 días, p = 0,014). La morbilidad a los 30 días fue menor en el grupo Stent, pero no de forma significativa (29,8 vs. 50%, p = 0,104), aunque sí lo fue la mortalidad (1,8 vs. 20%, p = 0,015). Respecto a los resultados oncológicos, no se encontraron diferencias significativas al comparar la supervivencia global, el intervalo libre de enfermedad, la supervivencia libre de recidiva local o a distancia ni la supervivencia libre de progresión. CONCLUSIONES: La utilización de stents cólicos como PAC de las neoplasias colorrectales oclusivas potencialmente resecables parece proporcionar mejores resultados quirúrgicos y resultados oncológicos equiparables a los de los pacientes intervenidos directamente

INTRODUCTION: The outcomes of patients treated with colonic stents as a bridge to surgery (BTS) have recently been questioned in terms of safety and long-term oncologic outcomes. The aim of this study is to evaluate the effects on surgical and oncologic outcomes of colonic stents as a BTS for potentially resectable obstructive colorectal cancer. METHODS: We conducted a retrospective analysis of patients operated on for potentially resectable obstructive colorectal cancer with or without distant disease between September 2002 and October 2015, comparing the patients treated with a colonic stent as a BTS (Stent group) with those directly operated on (Surgery group). RESULTS: Twenty patients underwent urgent surgery, while stent placement as a BTS was attempted in 57 patients. The Stent group had more patients treated with a laparoscopic approach (64.9 vs. 5%, P < .001), higher primary anastomosis rate (91.2 vs. 55%, P = .001), less need for stomata (10.5 vs. 50%, P = .001) and shorter postoperative hospital stay (7 vs. 12 days, P = .014). Thirty-day morbidity was reduced in the Stent group, although not significantly (29.8 vs. 50%, P = .104). However, 30-day mortality was significantly lower (1.8 vs. 20%, P = .015). Regarding the long-term oncologic outcomes, no significant differences were found when comparing overall survival, disease-free survival, local recurrence-free survival, distant recurrence-free survival or progression-free survival. CONCLUSIONS: Colonic stenting as a BTS for potentially resectable obstructive colorectal cancer seems to offer better surgical and equal long-term oncologic outcomes when compared to those of patients directly operated on

Impact on surgical and oncological results of the use of colonic stents as a bridge to surgery for potentially curable occlusive colorectal neoplasms. / Impacto de la utilización de stents colónicos como puente a la cirugía de neoplasias colorrectales oclusivas potencialmente curables sobre los resultados quirúrgicos y oncológicos.

INTRODUCTION: The outcomes of patients treated with colonic stents as a bridge to surgery (BTS) have recently been questioned in terms of safety and long-term oncologic outcomes. The aim of this study is to evaluate the effects on surgical and oncologic outcomes of colonic stents as a BTS for potentially resectable obstructive colorectal cancer. METHODS: We conducted a retrospective analysis of patients operated on for potentially resectable obstructive colorectal cancer with or without distant disease between September 2002 and October 2015, comparing the patients treated with a colonic stent as a BTS (Stent group) with those directly operated on (Surgery group). RESULTS: Twenty patients underwent urgent surgery, while stent placement as a BTS was attempted in 57 patients. The Stent group had more patients treated with a laparoscopic approach (64.9 vs. 5%, P<.001), higher primary anastomosis rate (91.2 vs. 55%, P=.001), less need for stomata (10.5 vs. 50%, P=.001) and shorter postoperative hospital stay (7 vs. 12 days, P=.014). Thirty-day morbidity was reduced in the Stent group, although not significantly (29.8 vs. 50%, P=.104). However, 30-day mortality was significantly lower (1.8 vs. 20%, P=.015). Regarding the long-term oncologic outcomes, no significant differences were found when comparing overall survival, disease-free survival, local recurrence-free survival, distant recurrence-free survival or progression-free survival. CONCLUSIONS: Colonic stenting as a BTS for potentially resectable obstructive colorectal cancer seems to offer better surgical and equal long-term oncologic outcomes when compared to those of patients directly operated on.