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International Journal of Colorectal Disease

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01.02.2020 | Original Article

Quasi-elective left colectomy after endoscopic colon stenting for obstructive cancer yields comparable oncologic outcome to full-elective operation

verfasst von: Nicolò Tamini, Marco Ceresoli, Simone Aldè, Francesca Carissimi, Lorenzo Ripamonti, Luca Nespoli, Marco Dinelli, Marco Braga, Luca Gianotti

Erschienen in: International Journal of Colorectal Disease | Ausgabe 4/2020

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Abstract

Purpose

Whether deferring surgery after endoscopic self-expandable metal stent (SEMS) placement for neoplastic stricture, and operating patients in a quasi-elective situation, may result in similar oncologic outcomes to elective operations is unclear. This study aimed to evaluate the disease-free survival (DFS) rates of patients who underwent an interval colon resection after SEMS placement or an elective operation with comparable cancer stages.

Methods

From a prospective dataset, we retrospectively selected patients with the following characteristics: (1) left-sided colon cancer and (2) cancer stage I to III. Exclusion criteria were as follows: (1) palliative surgery and (2) emergency operation. Then we stratified patients into two groups: (A) full-elective left colon resection and (B) quasi-elective left colon resection, defined as surgery performed after SEMS placement for obstructive colon cancer. DFS function was studied by the Kaplan-Meier method.

Results

After 1:2 matching based on cancer stage, 106 patients of the group A were compared with 53 patients of group B. In each group, there were 9.4% of stage I, 39.4% of stage II, and 50.9% of stage III patients. The rate of technical failure in SEMS placement was 3.8%. After a mean follow-up of 54 months, 16 (15.1%) patients in the full-elective groups and 10 (18.9%) in the quasi-elective group experience cancer recurrence (log rank = 0.588). DFS curve did not reach the median value.

Conclusions

SEMS placement with interval colon resection for obstructive neoplastic strictures seems to provide similar long-term oncologic outcomes to operations performed in an elective setting when a low rate of technical failure is achieved.

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Saida Y, Sumiyama Y, Nagao J, Uramatsu M (2003) Long-term prognosis of preoperative “bridge to surgery” expandable metallic stent insertion for obstructive colorectal cancer: comparison with emergency operation. Dis Colon Rectum 46(10 Suppl):S44–S49. https://doi.org/10.1097/01.DCR.0000087483.63718.A2 CrossRefPubMed

Ghazal A-HA, El-Shazly WG, Bessa SS, El-Riwini MT, Hussein AM (2013) Colonic endolumenal stenting devices and elective surgery versus emergency subtotal/total colectomy in the management of malignant obstructed left colon carcinoma. J Gastrointest Surg 17(6):1123–1129. https://doi.org/10.1007/s11605-013-2152-2 CrossRefPubMed

Arezzo A, Balague C, Targarona E, Borghi F, Giraudo G, Ghezzo L, Arroyo A, Sola-Vera J, de Paolis P, Bossotti M, Bannone E, Forcignanò E, Bonino MA, Passera R, Morino M (2017) Colonic stenting as a bridge to surgery versus emergency surgery for malignant colonic obstruction: results of a multicentre randomised controlled trial (ESCO trial). Surg Endosc 31(8):3297–3305. https://doi.org/10.1007/s00464-016-5362-3 CrossRefPubMed

Alcántara M, Serra-Aracil X, Falcó J, Mora L, Bombardó J, Navarro S (2011) Prospective, controlled, randomized study of intraoperative colonic lavage versus stent placement in obstructive left-sided colonic cancer. World J Surg 35:1904–1910. https://doi.org/10.1007/s00268-011-1139-y CrossRefPubMed

Ho K-S, Quah H-M, Lim J-F, Tang C-L, Eu K-W (2012 Mar) Endoscopic stenting and elective surgery versus emergency surgery for left-sided malignant colonic obstruction: a prospective randomized trial. Int J Color Dis 27(3):355–362. https://doi.org/10.1007/s00384-011-1331-4 CrossRef

Sloothaak DAM, van den Berg MW, Dijkgraaf MGW, Fockens P, Tanis PJ, van Hooft JE et al (2014) Oncological outcome of malignant colonic obstruction in the Dutch Stent-In 2 trial. Br J Surg 101:1751–1757. https://doi.org/10.1002/bjs.9645 CrossRefPubMed

Matsuda A, Miyashita M, Matsumoto S, Matsutani T, Sakurazawa N, Takahashi G, Kishi T, Uchida E (2015) Comparison of long-term outcomes of colonic stent as “bridge to surgery” and emergency surgery for malignant large-bowel obstruction: a meta-analysis. Ann Surg Oncol 22(2):497–504. https://doi.org/10.1245/s10434-014-3997-7 CrossRefPubMed

Cao Y, Gu J, Deng S, Li J, Wu K, Cai K (2019) Long-term tumour outcomes of self-expanding metal stents as “bridge to surgery” for the treatment of colorectal cancer with malignant obstruction: a systematic review and meta-analysis. Int J Color Dis 34:1827–1838. https://doi.org/10.1007/s00384-019-03372-5 CrossRef

Ceresoli M, Allievi N, Coccolini F, Montori G, Fugazzola P, Pisano M et al (2017) Long-term oncologic outcomes of stent as a bridge to surgery versus emergency surgery in malignant left side colonic obstructions: a meta-analysis. J Gastrointest Oncol 8(5):867–876. https://doi.org/10.21037/jgo.2017.09.04 CrossRefPubMedPubMedCentral

10.

Kang SI, Oh H-K, Yoo JS, Ahn S, Kim MH, Kim MJ, Son IT, Kim DW, Kang SB, Park YS, Yoon CJ, Shin R, Heo SC, Lee IT, Youk EG, Kim MJ, Chang TY, Park SC, Sohn DK, Oh JH, Park JW, Ryoo SB, Jeong SY, Park KJ, Seoul Colorectal Group (SECOG) (2018) Oncologic outcomes of preoperative stent insertion first versus immediate surgery for obstructing left-sided colorectal cancer. Surg Oncol 27(2):216–224. https://doi.org/10.1016/j.suronc.2018.04.002 CrossRefPubMed

11.

Park J, Lee HJ, Park SJ, Hur H, Min BS, Cheon JH et al (2018) Long-term outcomes after stenting as a bridge to surgery in patients with obstructing left-sided colorectal cancer. Int J Color Dis 33:799–807. https://doi.org/10.1007/s00384-018-3009-7 CrossRef

12.

Ho K-M, Chan K-M, Kwok S-Y, Lau PY-Y (2017) Colonic self-expanding metal stent (SEMS) as a bridge to surgery in left-sided malignant colonic obstruction: an 8-year review. Surg Endosc 31(5):2255–2262. https://doi.org/10.1007/s00464-016-5227-9 CrossRefPubMed

13.

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP et al (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370(9596):1453–1457. https://doi.org/10.1016/S0140-6736(07)61602-X CrossRef

14.

Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae CrossRefPubMedPubMedCentral

15.

Tejero E, Mainar A, Fernández L, Tobío R, De Gregorio MA (1994) New procedure for the treatment of colorectal neoplastic obstructions. Dis Colon Rectum 37(11):1158–1159. https://doi.org/10.1007/bf02049822 CrossRefPubMed

16.

Martinez-Santos C, Lobato RF, Fradejas JM, Pinto I, Ortega-Deballón P, Moreno-Azcoita M (2002) Self-expandable stent before elective surgery vs. emergency surgery for the treatment of malignant colorectal obstructions: comparison of primary anastomosis and morbidity rates. Dis Colon Rectum 45:401–406. https://doi.org/10.1007/s10350-004-6190-4 CrossRefPubMed

17.

Repici A, Conio M, Caronna S, De Angelis C, Costa CD, Morino M et al (2004) Early and late outcome of patients with obstructing colorectal cancer treated by stenting and elective surgery: a comparison with emergency surgery and patients operated without obstructive symptoms. Gastrointest Endosc 59:P275. https://doi.org/10.1016/s0016-5107(04)01217-9 CrossRef

18.

Ng KC, Law WL, Lee YM, Choi HK, Seto CL, Ho JWC (2006) Self-expanding metallic stent as a bridge to surgery versus emergency resection for obstructing left-sided colorectal cancer: a case-matched study. J Gastrointest Surg 10(6):798–803. https://doi.org/10.1016/j.gassur.2006.02.006 CrossRefPubMed

19.

Atukorale YN, Church JL, Hoggan BL, Lambert RS, Gurgacz SL, Goodall S, Maddern GJ (2016) Self-expanding metallic stents for the management of emergency malignant large bowel obstruction: a systematic review. J Gastrointest Surg 20(2):455–462. https://doi.org/10.1007/s11605-015-2997-7 CrossRefPubMed

20.

Arezzo A, Passera R, Lo Secco G, Verra M, Bonino MA, Targarona E et al (2017) Stent as bridge to surgery for left-sided malignant colonic obstruction reduces adverse events and stoma rate compared with emergency surgery: results of a systematic review and meta-analysis of randomized controlled trials. Gastrointest Endosc 86(3):416–426. https://doi.org/10.1016/j.gie.2017.03.1542 CrossRefPubMed

21.

Nathan H, Yin H, Wong SL (2017) Postoperative complications and long-term survival after complex cancer resection. Ann Surg Oncol 24(3):638–644CrossRefPubMed

22.

Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P (2011) Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg 253:890–899CrossRefPubMed

23.

Artinyan A, Orcutt ST, Anaya DA et al (2015) Infectious postoperative complications decrease long-term survival in patients undergoing curative surgery for colorectal cancer: a study of 12,075 patients. Ann Surg 261:497–505CrossRefPubMed

24.

Nespoli A, Gianotti L, Totis M, Bovo G, Nespoli L, Chiodini P, Brivio F (2004) Correlation between postoperative infections and long-term survival after colorectal resection for cancer. Tumori. 90(5):485–490CrossRefPubMed

25.

Avlund TH, Erichsen R, Ravn S, Ciplys Z, Andersen JC, Laurberg S, Iversen LH (2018) The prognostic impact of bowel perforation following self-expanding metal stent as a bridge to surgery in colorectal cancer obstruction. Surg Endosc 32(1):328–336. https://doi.org/10.1007/s00464-017-5680-0 CrossRefPubMed

26.

Gorissen KJ, Tuynman JB, Fryer E, Wang L, Uberoi R, Jones OM, Cunningham C, Lindsey I (2013) Local recurrence after stenting for obstructing left-sided colonic cancer. Br J Surg 100(13):1805–1809. https://doi.org/10.1002/bjs.9297 CrossRefPubMed

27.

Maruthachalam K, Lash GE, Shenton BK, Horgan AF (2007) Tumour cell dissemination following endoscopic stent insertion. Br J Surg 94(9):1151–1154. https://doi.org/10.1002/bjs.5790 CrossRefPubMed

28.

Yamashita S, Tanemura M, Sawada G, Moon J, Shimizu Y, Yamaguchi T, Kuwai T, Urata Y, Kuraoka K, Hatanaka N, Yamashita Y, Taniyama K (2018) Impact of endoscopic stent insertion on detection of viable circulating tumor cells from obstructive colorectal cancer. Oncol Lett 15(1):400–406. https://doi.org/10.3892/ol.2017.7339 CrossRefPubMed

29.

Amelung FJ, Borstlap WAA, Consten ECJ, Veld JV, van Halsema EE, Bemelman WA, Siersema PD, ter Borg F, van Hooft J, Tanis PJ, Dutch Snapshot Research Group (2019) Propensity score-matched analysis of oncological outcome between stent as bridge to surgery and emergency resection in patients with malignant left-sided colonic obstruction. Br J Surg 106(8):1075–1086. https://doi.org/10.1002/bjs.11172 CrossRefPubMed

30.

Lara-Romero C, Vilches Á, Caunedo-Álvarez Á, Hergueta-Delgado P, Lavín-Castejón I, Andrade-Bellido R, Alcaín-Martínez G (2019) Better recurrence-free survival after stent bridge to surgery compared to emergency surgery for obstructive left-sided colonic cancer in patients with stage III status of the American Joint Committee on Cancer (AJCC): a bicentric retrospective study. Int J Color Dis 34(7):1241–1250. https://doi.org/10.1007/s00384-019-03318-x CrossRef

31.

Gianotti L, Tamini N, Nespoli L, Rota M, Bolzonaro E, Frego R, Redaelli A, Antolini L, Ardito A, Nespoli A, Dinelli M (2013) A prospective evaluation of short-term and long-term results from colonic stenting for palliation or as a bridge to elective operation versus immediate surgery for large-bowel obstruction. Surg Endosc 27(3):832–842. https://doi.org/10.1007/s00464-012-2520-0 CrossRefPubMed

32.

Kim JS, Hur H, Min BS, Sohn SK, Cho CH, Kim NK (2009) Oncologic outcomes of self-expanding metallic stent insertion as a bridge to surgery in the management of left-sided colon cancer obstruction: comparison with nonobstructing elective surgery. World J Surg 33(6):1281–1286. https://doi.org/10.1007/s00268-009-0007-5 CrossRefPubMed

33.

Knight AL, Trompetas V, Saunders MP, Anderson HJ (2012) Does stenting of left-sided colorectal cancer as a “bridge to surgery” adversely affect oncological outcomes? A comparison with non-obstructing elective left-sided colonic resections. Int J Color Dis 27(11):1509–1514. https://doi.org/10.1007/s00384-012-1513-8 CrossRef

34.

Kulaylat AS, Pappou E, Philp MM, Kuritzkes BA, Ortenzi G, Hollenbeak CS, Choi C, Messaris E (2019) Emergent colon resections: does surgeon specialization influence outcomes? Dis Colon Rectum 62(1):79–87. https://doi.org/10.1097/DCR.0000000000001230 CrossRefPubMed

35.

Goldstone RN, Cauley CE, Chang DC, Kunitake H, Ricciardi R, Bordeianou L (2019) The effect of surgical training and operative approach on outcomes in acute diverticulitis: should guidelines be revised? Dis Colon Rectum 62(1):71–78. https://doi.org/10.1097/DCR.0000000000001240 CrossRefPubMed

36.

van Hooft JE, van Halsema EE, Vanbiervliet G, Beets-Tan RGH, DeWitt JM, Donnellan F et al (2014) Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Gastrointest Endosc 80(5):747–61.e1–75CrossRefPubMed

37.

Matsuda A, Miyashita M, Matsumoto S, Sakurazawa N, Takahashi G, Matsutani T, Yamada M, Uchida E (2016) Comparison between metallic stent and transanal decompression tube for malignant large-bowel obstruction. J Surg Res 205(2):474–481. https://doi.org/10.1016/j.jss.2016.04.055 CrossRefPubMed

38.

Robinson AG, Booth CM, Eisenhauer EA (2014) Disease-free survival as an end-point in the treatment of solid tumours – Perspectives from clinical trials and clinical practice. Eur J Cancer 50:2298–2302. https://doi.org/10.1016/j.ejca.2014.05.016 CrossRefPubMed

Titel: Quasi-elective left colectomy after endoscopic colon stenting for obstructive cancer yields comparable oncologic outcome to full-elective operation
verfasst von: Nicolò Tamini
Marco Ceresoli
Simone Aldè
Francesca Carissimi
Lorenzo Ripamonti
Luca Nespoli
Marco Dinelli
Marco Braga
Luca Gianotti
Publikationsdatum: 01.02.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: International Journal of Colorectal Disease / Ausgabe 4/2020
Print ISSN: 0179-1958
Elektronische ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-020-03519-9

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