Cargando…
Self-expandable metallic stenting as a bridge to elective surgery versus emergency surgery for acute malignant right-sided colorectal obstruction
BACKGROUND: The use of a self-expandable metallic stent (SEMS) as a bridge to surgery has increased for patients with obstructing colorectal cancer. However, relatively few reports have compared SEMS as a bridge to elective surgery for acute malignant obstruction of the right-sided colon (MORC) vs....
Autores principales: | , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7727111/ https://www.ncbi.nlm.nih.gov/pubmed/33302923 http://dx.doi.org/10.1186/s12893-020-00993-4 |
_version_ | 1783621032772370432 |
---|---|
author | Li, Bing Cai, Shi-Lun Lv, Zhen-Tao Zhou, Ping-Hong Yao, Li-Qing Shi, Qiang Qi, Zhi-Peng Sun, Di Yalikong, Ayimukedisi Xu, En-Pan Xu, Jian-Min Zhong, Yun-Shi |
author_facet | Li, Bing Cai, Shi-Lun Lv, Zhen-Tao Zhou, Ping-Hong Yao, Li-Qing Shi, Qiang Qi, Zhi-Peng Sun, Di Yalikong, Ayimukedisi Xu, En-Pan Xu, Jian-Min Zhong, Yun-Shi |
author_sort | Li, Bing |
collection | PubMed |
description | BACKGROUND: The use of a self-expandable metallic stent (SEMS) as a bridge to surgery has increased for patients with obstructing colorectal cancer. However, relatively few reports have compared SEMS as a bridge to elective surgery for acute malignant obstruction of the right-sided colon (MORC) vs. emergency surgery (ES). This study aimed to evaluate the benefits of elective surgery after SEMS placement vs. ES for patients (including stage IV cases) with acute MORC. METHODS: Patients with acute MORC who underwent radical resection for a primary tumour from July 2008 to November 2016 at Zhongshan Hospital of Fudan University were retrospectively enrolled. Postoperative short-term outcomes, progression-free survival (PFS), and overall survival (OS) were compared between the SEMS and ES groups. RESULTS: In total, 107 patients with acute MORC (35 in the SEMS group and 72 in the ES group) were included for analysis. The Intensive Care Unit admission rate was lower (11.4% vs. 34.7%, P = 0.011), the incidence of complications was reduced (11.4% vs. 29.2%, P = 0.042), and the postoperative length of hospitalisation was significantly shorter (8.23 ± 6.50 vs. 11.18 ± 6.71 days, P = 0.033) for the SEMS group. Survival curves showed no significant difference in PFS (P = 0.506) or OS (P = 0.989) between groups. Also, there was no significant difference in PFS and OS rates between patients with stage II and III colon cancer. After colectomy for synchronous liver metastases among stage IV patients, the hepatectomy rates for the SEMS and ES groups were 85.7% and 14.3%, respectively (P = 0.029). The hazard ratio for colectomy alone vs. combined resection was 3.258 (95% CI 0.858–12.370; P = 0.041). CONCLUSION: Stent placement offers significant advantages in terms of short-term outcomes and comparable prognoses for acute MORC patients. For synchronous liver metastases, SEMS placement better prepares the patient for resection of the primary tumour and liver metastasis, which contribute to improved survival. |
format | Online Article Text |
id | pubmed-7727111 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-77271112020-12-10 Self-expandable metallic stenting as a bridge to elective surgery versus emergency surgery for acute malignant right-sided colorectal obstruction Li, Bing Cai, Shi-Lun Lv, Zhen-Tao Zhou, Ping-Hong Yao, Li-Qing Shi, Qiang Qi, Zhi-Peng Sun, Di Yalikong, Ayimukedisi Xu, En-Pan Xu, Jian-Min Zhong, Yun-Shi BMC Surg Research Article BACKGROUND: The use of a self-expandable metallic stent (SEMS) as a bridge to surgery has increased for patients with obstructing colorectal cancer. However, relatively few reports have compared SEMS as a bridge to elective surgery for acute malignant obstruction of the right-sided colon (MORC) vs. emergency surgery (ES). This study aimed to evaluate the benefits of elective surgery after SEMS placement vs. ES for patients (including stage IV cases) with acute MORC. METHODS: Patients with acute MORC who underwent radical resection for a primary tumour from July 2008 to November 2016 at Zhongshan Hospital of Fudan University were retrospectively enrolled. Postoperative short-term outcomes, progression-free survival (PFS), and overall survival (OS) were compared between the SEMS and ES groups. RESULTS: In total, 107 patients with acute MORC (35 in the SEMS group and 72 in the ES group) were included for analysis. The Intensive Care Unit admission rate was lower (11.4% vs. 34.7%, P = 0.011), the incidence of complications was reduced (11.4% vs. 29.2%, P = 0.042), and the postoperative length of hospitalisation was significantly shorter (8.23 ± 6.50 vs. 11.18 ± 6.71 days, P = 0.033) for the SEMS group. Survival curves showed no significant difference in PFS (P = 0.506) or OS (P = 0.989) between groups. Also, there was no significant difference in PFS and OS rates between patients with stage II and III colon cancer. After colectomy for synchronous liver metastases among stage IV patients, the hepatectomy rates for the SEMS and ES groups were 85.7% and 14.3%, respectively (P = 0.029). The hazard ratio for colectomy alone vs. combined resection was 3.258 (95% CI 0.858–12.370; P = 0.041). CONCLUSION: Stent placement offers significant advantages in terms of short-term outcomes and comparable prognoses for acute MORC patients. For synchronous liver metastases, SEMS placement better prepares the patient for resection of the primary tumour and liver metastasis, which contribute to improved survival. BioMed Central 2020-12-10 /pmc/articles/PMC7727111/ /pubmed/33302923 http://dx.doi.org/10.1186/s12893-020-00993-4 Text en © The Author(s) 2020 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/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Article Li, Bing Cai, Shi-Lun Lv, Zhen-Tao Zhou, Ping-Hong Yao, Li-Qing Shi, Qiang Qi, Zhi-Peng Sun, Di Yalikong, Ayimukedisi Xu, En-Pan Xu, Jian-Min Zhong, Yun-Shi Self-expandable metallic stenting as a bridge to elective surgery versus emergency surgery for acute malignant right-sided colorectal obstruction |
title | Self-expandable metallic stenting as a bridge to elective surgery versus emergency surgery for acute malignant right-sided colorectal obstruction |
title_full | Self-expandable metallic stenting as a bridge to elective surgery versus emergency surgery for acute malignant right-sided colorectal obstruction |
title_fullStr | Self-expandable metallic stenting as a bridge to elective surgery versus emergency surgery for acute malignant right-sided colorectal obstruction |
title_full_unstemmed | Self-expandable metallic stenting as a bridge to elective surgery versus emergency surgery for acute malignant right-sided colorectal obstruction |
title_short | Self-expandable metallic stenting as a bridge to elective surgery versus emergency surgery for acute malignant right-sided colorectal obstruction |
title_sort | self-expandable metallic stenting as a bridge to elective surgery versus emergency surgery for acute malignant right-sided colorectal obstruction |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7727111/ https://www.ncbi.nlm.nih.gov/pubmed/33302923 http://dx.doi.org/10.1186/s12893-020-00993-4 |
work_keys_str_mv | AT libing selfexpandablemetallicstentingasabridgetoelectivesurgeryversusemergencysurgeryforacutemalignantrightsidedcolorectalobstruction AT caishilun selfexpandablemetallicstentingasabridgetoelectivesurgeryversusemergencysurgeryforacutemalignantrightsidedcolorectalobstruction AT lvzhentao selfexpandablemetallicstentingasabridgetoelectivesurgeryversusemergencysurgeryforacutemalignantrightsidedcolorectalobstruction AT zhoupinghong selfexpandablemetallicstentingasabridgetoelectivesurgeryversusemergencysurgeryforacutemalignantrightsidedcolorectalobstruction AT yaoliqing selfexpandablemetallicstentingasabridgetoelectivesurgeryversusemergencysurgeryforacutemalignantrightsidedcolorectalobstruction AT shiqiang selfexpandablemetallicstentingasabridgetoelectivesurgeryversusemergencysurgeryforacutemalignantrightsidedcolorectalobstruction AT qizhipeng selfexpandablemetallicstentingasabridgetoelectivesurgeryversusemergencysurgeryforacutemalignantrightsidedcolorectalobstruction AT sundi selfexpandablemetallicstentingasabridgetoelectivesurgeryversusemergencysurgeryforacutemalignantrightsidedcolorectalobstruction AT yalikongayimukedisi selfexpandablemetallicstentingasabridgetoelectivesurgeryversusemergencysurgeryforacutemalignantrightsidedcolorectalobstruction AT xuenpan selfexpandablemetallicstentingasabridgetoelectivesurgeryversusemergencysurgeryforacutemalignantrightsidedcolorectalobstruction AT xujianmin selfexpandablemetallicstentingasabridgetoelectivesurgeryversusemergencysurgeryforacutemalignantrightsidedcolorectalobstruction AT zhongyunshi selfexpandablemetallicstentingasabridgetoelectivesurgeryversusemergencysurgeryforacutemalignantrightsidedcolorectalobstruction |