Patients and Methods
Study Design and Population
Data Extraction
Outcome Parameters
Statistical Analysis
Results
Patient’s Characteristics
N = 1860 | Stent followed by resection (%) N = 44 | Stoma followed by resection (%) N = 42 | Acute resection (%) N = 1774 |
p value Stent versus stoma versus acute resection |
p value stent/stoma versus acute resection |
p value stent versus acute resection |
p value stoma versus acute resection |
---|---|---|---|---|---|---|---|
Male:female | 20:24 | 24:18 | 858:916 | 0.49 | 0.66 | 0.63 | 0.29 |
Mean age (range) | 69.9 (53–86) | 64.9 (35–89) | 71.4 (15–100) | <0.01 | 0.01 | 0.43 | <0.01 |
ASA score (N = 1830) | |||||||
I | 8/44 (18.2) | 7/42 (16.7) | 253/1744 (14.5) | 0.74 | 0.44 | 0.26 | 0.51 |
II | 23/44 (52.3) | 29/42 (69.0) | 877/1744 (50.3) | 0.06 | 0.08 | 0.52 | 0.05 |
III | 13/44 (29.5) | 6/42 (14.3) | 538/1744 (30.8) | 0.07 | 0.09 | 0.38 | 0.03 |
IV | 0/44 (0.0) | 0/42 (0.0) | 75/1774 (4.3) | 0.15 | 0.05 | 0.41 | 0.26 |
V | 0/44 (0.0) | 0/42 (0.0) | 1/1744 (0.1) | 0.98 | 0.82 | 0.88 | 0.87 |
Yeara (N = 1853) | |||||||
2009 | 9/264 (3.4) | 2/264 (0.7) | 253/264 (95.8) | ||||
2010 | 12/330 (3.6) | 11/330 (3.3) | 307/330 (93.0) | ||||
2011 | 11/401 (2.7) | 11/401 (2.7) | 379/401 (94.5) | ||||
2012 | 9/434 (2.0) | 7/434 (1.6) | 427/434 (96.9) | ||||
2013 | 2/415 (0.5)b
| 11/415 (2.7)b
| 402/415 (96.9)b
| ||||
Tumor localization (N = 1860) | |||||||
Cecum | 6/44 (13.7) | 16/42 (38.1) | 621/1774 (35.0) | <0.01 | 0.03 | <0.01 | 0.78 |
Ascending colon | 14/44 (31.8) | 6/42 (14.3) | 499/1774 (28.1) | 0.12 | 0.35 | 0.27 | 0.04 |
Hepatic flexure | 7/44 (15.9) | 6/42 (14.3) | 268/1774 (15.1) | 0.98 | 1.00 | 0.61 | 0.79 |
Transverse colon 5 | 17/44 (38.6) | 14/42 (33.3) | 386/1774 (21.8) | 0.07 | <0.01 | 0.19 | 0.05 |
pT4 stage (N = 1845) | 8/44 (18.2) | 20/42 (47.6) | 589/1759 (33.5) | 0.02 | 0.88 | 0.02 | 0.05 |
pN1–2 (N = 1832) | 21/44 (47.7) | 27/42 (65.9) | 1131/1747 (64.7) | 0.07 | 0.13 | 0.04 | 0.75 |
M1 stage (N = 1769) | 13/43 (30.2) | 15/41 (36.6) | 478/1712 (27.9) | 0.83 | 0.55 | 0.52 | 0.59 |
Postoperative chemotherapy yes/no (N = 1828) | 0.46 | 0.45 | 0.92 | 0.21 | |||
Adjuvant | 12/43 (27.9) | 16/42 (38.1) | 505/1743 (29.0) | 0.43 | 0.43 | 0.99 | 0.16 |
Palliative | 6/43 (14.0) | 6/42 (14.3) | 242/1743 (13.9) | 0.99 | 0.95 | 0.90 | 0.96 |
Surgical Characteristics
N = 1860 | Stent followed by resection (%) N = 44 | Stoma followed by resection (%) N = 42 | Acute resection (%) N = 1774 |
p value Stent versus stoma versus acute resection |
p value stent/stoma versus acute resection |
p value stent versus Acute resection |
p value stoma versus acute resection |
---|---|---|---|---|---|---|---|
Urgency of surgery (N = 1860) | |||||||
Elective | 35/44 (79.5) | 38/42 (90.5) | – | 0.16a
| – | – | – |
Urgent (not electively planned) | 5/44 (11.4) | 4/42 (9.5) | 936/1860 (52.8) | 0.67a
| – | – | – |
Emergency (<12 h) | 4/44 (9.1) | 0/42 (0.0) | 838/1860 (47.2) | 0.04a
| – | – | – |
Interval stent/stoma—resection (d) | – | – | – | ||||
Mean (SD) | 28.1 (30.9) | 109.9 (100.2) | – | 0.01 | – | – | – |
95% CI of mean | 8.4–47.7 | 65.4–154.3 | – | – | – | – | – |
Range | 0–118 | 0–358 | – | – | – | – | – |
Surgical procedure (N = 1858) | |||||||
Ileocecal resection | 0/44 (0.0) | 2/42 (1.8) | 77/1772 (4.3) | 0.36 | 0.37 | 0.18 | 0.95 |
(Extended) right hemicolectomy | 30/44 (68.2) | 24/42 (57.1) | 1423/1772 (80.3) | <0.01 | <0.01 | 0.38 | <0.01 |
Transversectomy | 6/44 (13.6) | 3/42 (7.1) | 107/1772 (6.0) | 0.12 | 0.10 | 0.30 | 0.42 |
(Extended) left hemicolectomy | 8/44 (18.2) | 7/42 (16.7) | 87/1772 (4.9) | <0.01 | <0.01 | <0.01 | <0.01 |
(Sub)total colectomy | 0/44 (0.0) | 4/42 (9.5) | 32/1772 (1.8) | 0.01 | 0.06 | 0.39 | <0.01 |
Other | 0/44 (0.0) | 2/42 (4.8) | 46/1772 (2.6) | 0.29 | 0.85 | 0.39 | 0.25 |
Surgical approach (N = 1858) | 0.03 | 0.04 | <0.01 | 0.98 | |||
Open | 34/44 (77.3) | 38/42 (90.5) | 1621/1772 (91.5) | ||||
Laparoscopic | 10/44 (22.7) | 4/42 (9.5) | 150/1772 (8.5) | ||||
Anastomosis constructed (N = 1845) | 42/44 (95.5) | 38/42 (90.5) | 1506/1759 (85.6) | 0.12 | 0.05 | 0.10 | 0.32 |
Stoma constructed after resection (n = 1600) | |||||||
No | 38/43 (88.4) | 34/42 (81.0) | 1454/1751 (83.0) | 0.61b
| 0.68b
| 0.14b
| 0.56b
|
Diverting ileostomy | 2/43 (4.7) | 4/42 (7.1) | 69/1751 (3.9) | 0.56 | 0.37 | 0.67 | 0.09 |
End ileostomy | 1/43 (2.3) | 0/42 (0.0) | 166/1751 (9.5) | 0.03 | <0.01 | 0.15 | 0.03 |
Diverting colostomy | 1/43 (2.3) | 3/42 (7.1) | 13/1751 (0.7) | <0.01 | <0.01 | 0.19 | <0.01 |
End colostomy | 1/43 (2.3) | 2/42 (4.8) | 47/1751 (2.7) | 0.71 | 0.64 | 0.30 | 0.47 |
Outcome Parameters
N = 1860 | Stent followed by resection n (%) N = 44 | Stoma followed by resection (%) N = 42 | Acute resection (%) N = 1774 |
p value stent versus stoma versus acute resection |
p value stent/stoma versus acute resection |
p value stent versus acute resection |
p value stoma versus acute resection |
---|---|---|---|---|---|---|---|
Complications within 30 days (N = 1850) | 12/44 (27.3) | 13/41 (31.7) | 699/1765 (39.6) | 0.17 | 0.07 | 0.05 | 0.22 |
Reintervention (N = 1082) | 8/28 (28.6) | 10/29 (34.5) | 240/1025 (23.4) | 0.32 | 0.20 | 0.63 | 0.18 |
Reintervention indication | 0.92 | 0.89 | 0.95 | 0.57 | |||
Anastomotic leakage | 2 (22.2) | 5 (50.0) | 111 (42.5) | 0.42 | 0.63 | 0.32 | 0.63 |
Abscess | 1 (11.1) | 1 (10.0) | 29 (11.1) | 0.99 | 0.94 | 0.90 | 0.92 |
Re-bleeding | 1 (11.1) | 0 (0.0) | 16 (6.1) | 0.59 | 0.88 | 0.46 | 0.42 |
Ileus | 1 (11.1) | 0 (0.0) | 15 (15.7) | 0.58 | 0.93 | 0.42 | 0.44 |
Fascia dehiscence | 2 (22.2) | 4 (40.0) | 41 (15.7) | 0.12 | 0.07 | 0.47 | 0.04 |
Other | 0 (0.0) | 0 (0.0) | 2 (0.8) | 0.30 | 0.37 | 0.64 | 0.13 |
Type of reintervention (N = 262) | |||||||
Radiological | 1 (12.5) | 1 (10.0) | 26 (6.2) | 0.91 | 0.67 | 0.55 | 0.82 |
Laparoscopy | 1 (12.5) | 1 (10.0) | 2 (1.6) | <0.01 | <0.01 | <0.01 | <0.01 |
Laparotomy | 4 (50.0) | 5 (50.0) | 196 (81.6) | 0.21 | 0.08 | 0.09 | 0.24 |
Other/unknown | 2 (25.0) | 3 (30.0) | 16 (6.6) | 0.08 | 0.03 | 0.05 | 0.12 |
Completeness of resection (N = 1738) | |||||||
R0 | 37/40 (92.5) | 33/39 (84.6) | 1524/1659 (91.9) | 0.26 | 0.30 | 0.97 | 0.13 |
R1 | 1/40 (2.5) | 6/39 (15.4) | 76/1659 (4.6) | <0.01 | 0.08 | 0.60 | 0.01 |
R2 | 2/40 (5.0) | 0/39 (0.0) | 58/1659 (3.5) | 0.43 | 0.65 | 0.50 | 0.22 |
30-day mortality (N = 1843) | 1/42 (2.4) | 1/42 (2.4) | 155/1759 (8.8) | 0.17 | 0.04 | 0.16 | 0.17 |
≤70 years | – | – | 36/815 (4.4) | ||||
>70 years | – | – | 118/947 (12.5)a
| ||||
ASA 1–2 | – | – | 59/1186 (5.0) | ||||
ASA 3–5 | – | – | 97/629 (15.4)b
| ||||
Ileocecal resection/right hemicolectomy | – | – | 125/1489 (8.4) | ||||
Transversectomy/left hemicolectomy/subtotal colectomy | – | – | 26/240 (10.8)c
|