Colonic perforation either during or after stent insertion as a bridge to surgery for malignant colorectal obstruction increases the risk ... View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2015-02-13

AUTHORS

Su Jin Kim, Hyung Wook Kim, Su Bum Park, Dae Hwan Kang, Cheol Woong Choi, Byeong Jun Song, Joung Boom Hong, Dong Jun Kim, Byung Soo Park, Gyung Mo Son

ABSTRACT

Background Endoscopic colorectal stenting may be performed as a bridge to surgery in patients with malignant colorectal obstruction, and has been reported to be associated with a high rate of successful primary anastomosis, low rate of stoma formation, and shorter hospital stay. However, the results of recent studies suggest that colorectal stenting could potentially worsen the prognosis. This study aimed to compare outcomes between patients who underwent colorectal stenting as a bridge to surgery and patients who underwent curative surgery only for malignant colorectal obstruction.MethodsThis study included patients with malignant colorectal obstruction and symptomatic bowel dilatation who were treated by stenting as a bridge to surgery (stent group, n = 27) or surgical resection only (surgery-only group, n = 29) between May 2009 and May 2012. The short-term outcomes evaluated were the primary anastomosis rate, length of hospital stay, and rates of emergency and open surgery. The long-term outcomes evaluated were overall survival (OS) and recurrence-free survival (RFS).ResultsThe primary outcomes were similar in the two groups. There were no significant differences between the stent and surgery-only groups in 3-year OS (85.2 vs. 82.8 %; p = 0.655) or 3-year RFS (80.7 vs. 78.6 %; p = 0.916). The odds ratio for seeded metastasis after perforation either during or after stent placement was 46.0 (95 % CI, 2.0–1,047.8; p = 0.016).ConclusionsColorectal stenting as a bridge to surgery showed no significant short- or long-term benefits compared with surgery only, and was associated with peritoneal seeding after perforation. Stenting before surgery should therefore only be considered in patients with a high risk of complications associated with emergency surgery. More... »

PAGES

3499-3506

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00464-015-4100-6

DOI

http://dx.doi.org/10.1007/s00464-015-4100-6

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1001888233

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/25676202


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33 schema:description Background Endoscopic colorectal stenting may be performed as a bridge to surgery in patients with malignant colorectal obstruction, and has been reported to be associated with a high rate of successful primary anastomosis, low rate of stoma formation, and shorter hospital stay. However, the results of recent studies suggest that colorectal stenting could potentially worsen the prognosis. This study aimed to compare outcomes between patients who underwent colorectal stenting as a bridge to surgery and patients who underwent curative surgery only for malignant colorectal obstruction.MethodsThis study included patients with malignant colorectal obstruction and symptomatic bowel dilatation who were treated by stenting as a bridge to surgery (stent group, n = 27) or surgical resection only (surgery-only group, n = 29) between May 2009 and May 2012. The short-term outcomes evaluated were the primary anastomosis rate, length of hospital stay, and rates of emergency and open surgery. The long-term outcomes evaluated were overall survival (OS) and recurrence-free survival (RFS).ResultsThe primary outcomes were similar in the two groups. There were no significant differences between the stent and surgery-only groups in 3-year OS (85.2 vs. 82.8 %; p = 0.655) or 3-year RFS (80.7 vs. 78.6 %; p = 0.916). The odds ratio for seeded metastasis after perforation either during or after stent placement was 46.0 (95 % CI, 2.0–1,047.8; p = 0.016).ConclusionsColorectal stenting as a bridge to surgery showed no significant short- or long-term benefits compared with surgery only, and was associated with peritoneal seeding after perforation. Stenting before surgery should therefore only be considered in patients with a high risk of complications associated with emergency surgery.
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42 anastomosis
43 anastomosis rate
44 background
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46 bowel dilatation
47 bridge
48 colonic perforation
49 colorectal obstruction
50 colorectal stenting
51 complications
52 curative surgery
53 differences
54 dilatation
55 emergency
56 emergency surgery
57 formation
58 group
59 high rate
60 high risk
61 hospital stay
62 insertion
63 length
64 long-term benefits
65 long-term outcomes
66 lower rates
67 malignant colorectal obstruction
68 metastasis
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70 odds ratio
71 open surgery
72 outcomes
73 overall survival
74 patients
75 perforation
76 peritoneal seeding
77 placement
78 primary anastomosis
79 primary anastomosis rate
80 primary outcome
81 prognosis
82 rate
83 rates of emergency
84 ratio
85 recurrence-free survival
86 resection
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92 shorter hospital stay
93 significant differences
94 stay
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96 stent placement
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101 surgery
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