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Background: Although self-expandable metal stent (SEMS) placement as bridge to surgery (BTS) in patients with left-sided obstructing colonic cancer has shown promising short-term results, it is used infrequently owing to uncertainty about its oncological safety. This population study compared long-term oncological outcomes between emergency resection and SEMS placement as BTS.

Methods: Through a national collaborative research project, long-term outcome data were collected for all patients who underwent resection for left-sided obstructing colonic cancer between 2009 and 2016 in 75 Dutch hospitals. Patients were identified from the Dutch Colorectal Audit database. SEMS as BTS was compared with emergency resection in the curative setting after 1 : 2 propensity score matching.

Results: Some 222 patients who had a stent placed were matched to 444 who underwent emergency resection. The overall SEMS-related perforation rate was 7·7 per cent (17 of 222). Three-year locoregional recurrence rates after SEMS insertion and emergency resection were 11·4 and 13·6 per cent (P = 0·457), disease-free survival rates were 58·8 and 52·6 per cent (P = 0·175), and overall survival rates were 74·0 and 68·3 per cent (P = 0·231), respectively. SEMS placement resulted in significantly fewer permanent stomas (23·9 versus 45·3 per cent; P < 0·001), especially in elderly patients (29·0 versus 57·9 per cent; P < 0·001). For patients in the SEMS group with or without perforation, 3-year locoregional recurrence rates were 18 and 11·0 per cent (P = 0·432), disease-free survival rates were 49 and 59·6 per cent (P = 0·717), and overall survival rates 61 and 75·1 per cent (P = 0·529), respectively.

Conclusion: Overall, SEMS as BTS seems an oncologically safe alternative to emergency resection with fewer permanent stomas. Nevertheless, the risk of SEMS-related perforation, as well as permanent stoma, might influence shared decision-making for individual patients.

Titel:	Propensity score-matched analysis of oncological outcome between stent as bridge to surgery and emergency resection in patients with malignant left-sided colonic obstruction.
Autor/in / Beteiligte Person:	Amelung, FJ ; Borstlap, WAA ; Consten, ECJ ; Veld, JV ; van Halsema EE ; Bemelman, WA ; Siersema, PD ; Ter Borg, F ; van Hooft JE ; Tanis, PJ
Zeitschrift:	The British journal of surgery, Jg. 106 (2019-07-01), Heft 8, S. 1075-1086
Veröffentlichung:	2021- : [Oxford] : Oxford University Press on behalf of BJS Foundation Ltd. ; <i>Original Publication</i>: [Bristol, England : Baltimore : John Wright & Sons ; Williams & Wilkins Co., 2019
Medientyp:	academicJournal
ISSN:	1365-2168 (electronic)
DOI:	10.1002/bjs.11172
Schlagwort:	Aged Aged, 80 and over Colon injuries Colon surgery Colonic Neoplasms complications Emergency Treatment Female Humans Intestinal Obstruction etiology Intestinal Perforation epidemiology Intestinal Perforation etiology Male Middle Aged Netherlands Propensity Score Treatment Outcome Colonic Neoplasms surgery Intestinal Obstruction surgery Prosthesis Implantation methods Prosthesis Implantation statistics & numerical data Self Expandable Metallic Stents adverse effects Self Expandable Metallic Stents statistics & numerical data
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Corporate Authors: Dutch Snapshot Research Group Publication Type: Journal Article Language: English [Br J Surg] 2019 Jul; Vol. 106 (8), pp. 1075-1086. <i>Date of Electronic Publication: </i>2019 May 10. MeSH Terms: Prosthesis Implantation* / methods ; Prosthesis Implantation* / statistics & numerical data ; Self Expandable Metallic Stents* / adverse effects ; Self Expandable Metallic Stents* / statistics & numerical data ; Colonic Neoplasms / surgery ; Intestinal Obstruction / surgery ; Aged ; Aged, 80 and over ; Colon / injuries ; Colon / surgery ; Colonic Neoplasms / complications ; Emergency Treatment ; Female ; Humans ; Intestinal Obstruction / etiology ; Intestinal Perforation / epidemiology ; Intestinal Perforation / etiology ; Male ; Middle Aged ; Netherlands ; Propensity Score ; Treatment Outcome Contributed Indexing: Investigator: H Algera; GD Algie; CS Andeweg; T Argillander; MNNJ Arron; K Arts; THJ Aufenacker; IS Bakker; M van Basten Batenburg; AJNM Bastiaansen; GL Beets; A van den Berg; B van de Beukel; RLGM Blom; B Blomberg; EG Boerma; FC den Boer; ND Bouvy; JE Bouwman; NDA Boye; ARM Brandt; HT Brandsma; A Breijer; W van den Broek; MEE Bröker; JPM Burbach; ERJ Bruns; TA Burghgraef; RMPH Crolla; M Dam; L Daniels; JWT Dekker; A Demirkiran; K van Dongen; SF Durmaz; A van Esch; JA van Essen; JW Foppen; EJB Furnee; AAW van Geloven; MF Gerhards; EA Gorter; WMU van Grevenstein; J van Groningen; I de Groot; H Haak; JWA de Haas; P van Hagen; JTH Hamminga; K Havenga; B van den Hengel; E van der Harst; J Heemskerk; J Heeren; BHM Heijnen; L Heijnen; JT Heikens; M van Heinsbergen; DA Hess; N Heuchemer; C Hoff; W Hogendoorn; APJ Houdijk; N Hugen; B Inberg; T Janssen; DJ Pierre; WJ de Jong; ACHM Jongen; AV Kamman; JM Klaase; W Kelder; EF Kelling; R Klicks; GW De Klein; FWH Kloppenberg; JLM Konsten; LJER Koolen; V Kornmann; RTJ Kortekaas; A Kreiter; B Lamme; JF Lange; T Lettinga; D Lips; G Lo; F Logeman; YT van Loon; MFL Holzik; CCM Marres; I Masselink; A Mearadji; G Meisen; AG Menon; J Merkus; D de Mey; HCJ van der Mijle; DE Moes; C Molenaar; MJ Nieboer; K Nielsen; GAP Nieuwenhuijzen; PA Neijenhuis; P Oomen; N van Oorschot; K Parry; KCMJ Peeters; T Paulides; I Paulusma; FB Poelmann; SW Polle; P Poortman; M Raber; RJ Renger; BMM Reiber; R Roukema; WMJ de Ruijter; MJAM Russchen; HJT Rutten; J Scheerhoorn; S Scheurs; H Schippers; VNE Schuermans; HJ Schuijt; JC Sierink; C Sietses; R Silvis; J van der Slegt; G Slooter; M van de Sluis; P van der Sluis; N Smakman; D Smit; TC van Sprundel; DJA Sonneveld; C Steur; J Straatman; MC Struijs; HA Swank; AK Talsma; M Tenhagen; JAMG Tol; JL Tolenaar; L Tseng; JB Tuynman; MJF van Veen; S Veltkamp; AWH van de Ven; L Verkoele; M Vermaas; HP Versteegh; L Versluijs; T Visser; D van Uden; WJ Vles; R de Vos Tot Nederveen Cappel; HS de Vries; ST van Vugt; G Vugts; JA Wegdam; T Weijs; BJ van Wely; C Werker; M Westerterp; HL van Westreenen; B Wiering; NAT Wijffels; AA Wijkman; LH Wijngaarden; JHW de Wilt; M van de Wilt; DD Wisselink; F Wit; ES van der Zaag; D Zimmerman; T Zwols Entry Date(s): Date Created: 20190511 Date Completed: 20200114 Latest Revision: 20200114 Update Code: 20231215

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Propensity score-matched analysis of oncological outcome between stent as bridge to surgery and emergency resection in patients with malignant left-sided colonic obstruction.