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Preoperative stents for the treatment of obstructing left-sided colon cancer: a national analysis

BACKGROUND: Given the risks associated with urgent colectomy for large bowel obstruction, preoperative colonic stenting has been utilized for decompression and optimization prior to surgery. This study examined national trends in the use of colonic stenting as a bridge to resection for malignant lar...

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Autores principales: Hadaya, Joseph, Verma, Arjun, Sanaiha, Yas, Mabeza, Russyan Mark, Chen, Formosa, Benharash, Peyman
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10017588/
https://www.ncbi.nlm.nih.gov/pubmed/36220989
http://dx.doi.org/10.1007/s00464-022-09650-8
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author Hadaya, Joseph
Verma, Arjun
Sanaiha, Yas
Mabeza, Russyan Mark
Chen, Formosa
Benharash, Peyman
author_facet Hadaya, Joseph
Verma, Arjun
Sanaiha, Yas
Mabeza, Russyan Mark
Chen, Formosa
Benharash, Peyman
author_sort Hadaya, Joseph
collection PubMed
description BACKGROUND: Given the risks associated with urgent colectomy for large bowel obstruction, preoperative colonic stenting has been utilized for decompression and optimization prior to surgery. This study examined national trends in the use of colonic stenting as a bridge to resection for malignant large bowel obstruction and evaluated outcomes relative to immediate colectomy. METHODS: Adults undergoing colonic stenting or colectomy for malignant, left/sigmoid large bowel obstruction were identified in the 2010–2016 Nationwide Readmissions Database. Patients were classified as immediate resection (IR) or delayed resection (DR) if undergoing colonic stenting prior to colectomy. Generalized linear models were used to evaluate the impact of resection strategy on ostomy creation, in-hospital mortality, and complications. RESULTS: Among 9,706 patients, 9.7% underwent colonic stenting, which increased from 7.7 to 16.4% from 2010 to 2016 (p < 0.001). Compared to IR, the DR group was younger (63.9 vs 65.9 years, p = 0.04), had fewer comorbidities (Elixhauser Index 3.5 vs 3.9, p = 0.001), and was more commonly managed at high-volume centers (89.4% vs 68.1%, p < 0.001). Laparoscopic resections were more frequent among the DR group (33.1% vs 13.0%, p < 0.001), while ostomy rates were significantly lower (21.5% vs 53.0%, p < 0.001). After risk adjustment, colonic stenting was associated with reduced odds of ostomy creation (0.34, 95% confidence interval 0.24–0.46), but similar odds of mortality and complications. CONCLUSION: Colonic stenting is increasingly utilized for malignant, left-sided bowel obstructions, and associated with lower ostomy rates but comparable clinical outcomes. These findings suggest the relative safety of colonic stenting for malignant large bowel obstruction when clinically appropriate. GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00464-022-09650-8.
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spelling pubmed-100175882023-03-17 Preoperative stents for the treatment of obstructing left-sided colon cancer: a national analysis Hadaya, Joseph Verma, Arjun Sanaiha, Yas Mabeza, Russyan Mark Chen, Formosa Benharash, Peyman Surg Endosc Original Article BACKGROUND: Given the risks associated with urgent colectomy for large bowel obstruction, preoperative colonic stenting has been utilized for decompression and optimization prior to surgery. This study examined national trends in the use of colonic stenting as a bridge to resection for malignant large bowel obstruction and evaluated outcomes relative to immediate colectomy. METHODS: Adults undergoing colonic stenting or colectomy for malignant, left/sigmoid large bowel obstruction were identified in the 2010–2016 Nationwide Readmissions Database. Patients were classified as immediate resection (IR) or delayed resection (DR) if undergoing colonic stenting prior to colectomy. Generalized linear models were used to evaluate the impact of resection strategy on ostomy creation, in-hospital mortality, and complications. RESULTS: Among 9,706 patients, 9.7% underwent colonic stenting, which increased from 7.7 to 16.4% from 2010 to 2016 (p < 0.001). Compared to IR, the DR group was younger (63.9 vs 65.9 years, p = 0.04), had fewer comorbidities (Elixhauser Index 3.5 vs 3.9, p = 0.001), and was more commonly managed at high-volume centers (89.4% vs 68.1%, p < 0.001). Laparoscopic resections were more frequent among the DR group (33.1% vs 13.0%, p < 0.001), while ostomy rates were significantly lower (21.5% vs 53.0%, p < 0.001). After risk adjustment, colonic stenting was associated with reduced odds of ostomy creation (0.34, 95% confidence interval 0.24–0.46), but similar odds of mortality and complications. CONCLUSION: Colonic stenting is increasingly utilized for malignant, left-sided bowel obstructions, and associated with lower ostomy rates but comparable clinical outcomes. These findings suggest the relative safety of colonic stenting for malignant large bowel obstruction when clinically appropriate. GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00464-022-09650-8. Springer US 2022-10-11 2023 /pmc/articles/PMC10017588/ /pubmed/36220989 http://dx.doi.org/10.1007/s00464-022-09650-8 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Article
Hadaya, Joseph
Verma, Arjun
Sanaiha, Yas
Mabeza, Russyan Mark
Chen, Formosa
Benharash, Peyman
Preoperative stents for the treatment of obstructing left-sided colon cancer: a national analysis
title Preoperative stents for the treatment of obstructing left-sided colon cancer: a national analysis
title_full Preoperative stents for the treatment of obstructing left-sided colon cancer: a national analysis
title_fullStr Preoperative stents for the treatment of obstructing left-sided colon cancer: a national analysis
title_full_unstemmed Preoperative stents for the treatment of obstructing left-sided colon cancer: a national analysis
title_short Preoperative stents for the treatment of obstructing left-sided colon cancer: a national analysis
title_sort preoperative stents for the treatment of obstructing left-sided colon cancer: a national analysis
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10017588/
https://www.ncbi.nlm.nih.gov/pubmed/36220989
http://dx.doi.org/10.1007/s00464-022-09650-8
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