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Upfront surgery versus self-expanding metallic stent as bridge to surgery in left-sided colonic cancer obstruction: A multicenter observational study

Abstract: Background: Oncological outcomes of self-expanding metallic stent used as a bridge to surgery in potential curative patients with left-sided colonic cancer obstruction remain unclear. The aim of this study was to investigate perioperative and mid-term oncological outcomes of 2 of the currently most commonly performed treatments in left-sided colonic cancer obstruction. Methods: This is a retrospective multicenter study including patients with left-sided colonic cancer obstruction treated with curative intent between 2013 and 2017. The presence of metastasis at diagnosis was an exclusion criterion. The primary outcome was to evaluate the noninferiority, in terms of overall survival, of bridge to surgery strategy compared with emergency colonic resection. The secondary outcomes were perioperative morbimortality, disease free survival, local recurrence, and distant recurrence. Results: A total of 564 patients were included, 320 in the emergency colonic resection group and 244 in the bridge to surgery group. Twenty-seven patients of the bridge-to-surgery group needed urgent operation. Postoperative morbidity rates were statistically higher in the emergency colonic resection group (odds ratio [95% confidence interval] 0.37 [0.24-0.55], P < .001). There was no difference in 90-day mortality between groups (odds ratio [95% confidence interval] 0.85 [0.36-1.99], P = .702). The median follow-up was 3.80 years (2.29-4.92). The results show the noninferiority of bridge to surgery versus emergency colonic resection in terms of overall survival (hazard ratio [95% confidence interval) 0.78 [0.56-1.07], P = .127). There were no differences in disease free survival, distant recurrence, and local recurrence rates between bridge to surgery and emergency colonic resection groups. Conclusion: Self-expanding metallic stent as bridge to surgery might not lead to a negative impact on the long-term prognosis of the tumor compared with emergency colonic resection in expert hands and selected patients.

 Fuente: Surgery . 2022 Jul;172(1):74-82

Editorial: Elsevier

 Año de publicación: 2022

Nº de páginas: 9

Tipo de publicación: Artículo de Revista

 DOI: 10.1016/j.surg.2021.12.035

ISSN: 0039-6060,1532-7361

Url de la publicación: https://doi.org/10.1016/j.surg.2021.12.035

Autoría

HIDALGO-PUJOL, MARTA

BIONDO, SEBASTIANO

DIE TRILL, JAVIER

VIGORITA, VINCENZO

PANIAGUA GARCIA-SEÑORANS, MARTA

PASCUAL MIGUELÁÑEZ, ISABEL

PRIETO-LA NOIRE, FERNANDO

TIMOTEO, ANDER

CORNEJO, LIDIA

FIDALGO GARCÍA, MARÍA

SOLÍS-PEÑA, ALEJANDRO

CIRERA DE TUDELA, ARTURO

RODRIGUEZ GONZÁLEZ, ARACELI

SÁNCHEZ-GUILLEN, LUÍS

BUSTAMANTE RECUENCO, CARLOS

PÉREZ-ALONSO, CARLA

HURTADO CABALLERO, ELENA

PASCUAL, MARTA

GARCÍA SEPTIEM, JAVIER