Oncologic safety of laparoscopic surgery after metallic stent insertion for obstructive left-sided colorectal cancer: a multicenter comparative study View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2021-01-25

AUTHORS

Min Hyun Kim, Sung Il Kang, Jeehye Lee, Heung-Kwon Oh, Soyeon Ahn, Duck-Woo Kim, Sung-Bum Kang, Rumi Shin, Seung Chul Heo, Eui Gon Youk, Sung-Chan Park, Dae Kyung Sohn, Jae Hwan Oh, Min Jung Kim, Ji Won Park, Seung-Bum Ryoo, Seung-Yong Jeong, Kyu Joo Park,

ABSTRACT

BackgroundSelf-expanding metallic stents (SEMSs) are used as a bridge to surgery in patients with obstructive colorectal cancer. However, the role of laparoscopic resection after successful stent deployment is not well established. We aimed to compare the oncologic outcomes of laparoscopic vs open surgery after successful colonic stent deployment in patients with obstructive left-sided colorectal cancer.MethodsIn this multicenter study, 179 (97 laparoscopy, 82 open surgery) patients with obstructive left-sided colorectal cancer who underwent radical resection with curative intent after successful stent deployment were retrospectively reviewed. To minimize bias, we used inverse probability treatment-weighted propensity score analysis. The short- and long-term outcomes between the groups were compared.ResultsBoth groups had similar demographic and tumor characteristics. The operation time was longer, but the degree of blood loss was lower in the laparoscopy than in the open surgery group. There were nine (9.3%) open conversions. After adjustment, the groups showed similar patient and tumor characteristics. The 5-year disease-free survival (DFS) (laparoscopic vs open: 68.7% vs 48.5%, p = 0.230) and overall survival (OS) (laparoscopic vs open: 79.1% vs 69.0%, p = 0.200) estimates did not differ significantly across a median follow-up duration of 50.5 months. Advanced stage disease (DFS: hazard ratio [HR] 1.825, 95% confidence interval [CI]: 1.072–3.107; OS: HR 2.441, 95% CI 1.216–4.903) and post-operative chemotherapy omission (DFS: HR 2.529, 95% CI 1.481–4.319; OS: HR 2.666, 95% CI 1.370–5.191) were associated with relatively worse long-term outcomes.ConclusionStent insertion followed by laparoscopy with curative intent is safe and feasible; the addition of post-operative chemotherapy should be considered after successful treatment. More... »

PAGES

1-11

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00464-021-08293-5

DOI

http://dx.doi.org/10.1007/s00464-021-08293-5

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1134850158

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/33492504


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11 schema:description BackgroundSelf-expanding metallic stents (SEMSs) are used as a bridge to surgery in patients with obstructive colorectal cancer. However, the role of laparoscopic resection after successful stent deployment is not well established. We aimed to compare the oncologic outcomes of laparoscopic vs open surgery after successful colonic stent deployment in patients with obstructive left-sided colorectal cancer.MethodsIn this multicenter study, 179 (97 laparoscopy, 82 open surgery) patients with obstructive left-sided colorectal cancer who underwent radical resection with curative intent after successful stent deployment were retrospectively reviewed. To minimize bias, we used inverse probability treatment-weighted propensity score analysis. The short- and long-term outcomes between the groups were compared.ResultsBoth groups had similar demographic and tumor characteristics. The operation time was longer, but the degree of blood loss was lower in the laparoscopy than in the open surgery group. There were nine (9.3%) open conversions. After adjustment, the groups showed similar patient and tumor characteristics. The 5-year disease-free survival (DFS) (laparoscopic vs open: 68.7% vs 48.5%, p = 0.230) and overall survival (OS) (laparoscopic vs open: 79.1% vs 69.0%, p = 0.200) estimates did not differ significantly across a median follow-up duration of 50.5 months. Advanced stage disease (DFS: hazard ratio [HR] 1.825, 95% confidence interval [CI]: 1.072–3.107; OS: HR 2.441, 95% CI 1.216–4.903) and post-operative chemotherapy omission (DFS: HR 2.529, 95% CI 1.481–4.319; OS: HR 2.666, 95% CI 1.370–5.191) were associated with relatively worse long-term outcomes.ConclusionStent insertion followed by laparoscopy with curative intent is safe and feasible; the addition of post-operative chemotherapy should be considered after successful treatment.
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16 schema:keywords BackgroundSelf
17 ConclusionStent insertion
18 MethodsIn
19 ResultsBoth groups
20 addition
21 adjustment
22 advanced stage disease
23 analysis
24 bias
25 blood loss
26 bridge
27 cancer
28 characteristics
29 chemotherapy
30 chemotherapy omission
31 colonic stent deployment
32 colorectal cancer
33 comparative study
34 conversion
35 curative intent
36 degree
37 deployment
38 disease
39 disease-free survival
40 duration
41 estimates
42 follow
43 group
44 insertion
45 intent
46 inverse probability treatment-weighted propensity score analysis
47 laparoscopic
48 laparoscopic resection
49 laparoscopic surgery
50 laparoscopy
51 left-sided colorectal cancer
52 long-term outcomes
53 loss
54 median follow
55 metallic stent insertion
56 metallic stents
57 months
58 multicenter comparative study
59 multicenter study
60 obstructive colorectal cancer
61 obstructive left-sided colorectal cancer
62 omission
63 oncologic outcomes
64 oncologic safety
65 open conversion
66 open surgery
67 open surgery group
68 operation time
69 outcomes
70 patients
71 post-operative chemotherapy
72 post-operative chemotherapy omission
73 probability treatment-weighted propensity score analysis
74 propensity score analysis
75 radical resection
76 resection
77 role
78 safety
79 score analysis
80 similar patients
81 stage disease
82 stent deployment
83 stent insertion
84 stents
85 study
86 successful colonic stent deployment
87 successful stent deployment
88 successful treatment
89 surgery
90 surgery group
91 survival
92 time
93 treatment
94 treatment-weighted propensity score analysis
95 tumor characteristics
96 worse long-term outcomes
97 schema:name Oncologic safety of laparoscopic surgery after metallic stent insertion for obstructive left-sided colorectal cancer: a multicenter comparative study
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