Fluoroscopic Stenting as a Bridge to Surgery versus Emergency Management for Malignant Obstruction of the Colon

Fan Xue; Feng Lin; Jun Zhou; Ning Feng; You-Gang Cui; Xu Zhang; Yu-Peng Yi; Wen-Zhi Liu

doi:10.1155/2020/4650780

Fluoroscopic Stenting as a Bridge to Surgery versus Emergency Management for Malignant Obstruction of the Colon

Emerg Med Int. 2020 Jun 1:2020:4650780. doi: 10.1155/2020/4650780. eCollection 2020.

Authors

Fan Xue¹, Feng Lin¹, Jun Zhou², Ning Feng¹, You-Gang Cui¹, Xu Zhang¹, Yu-Peng Yi¹, Wen-Zhi Liu¹

Affiliations

¹ Department of Gastrointestinal Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, Liaoning Province, China.
² Department of Intervention, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, Liaoning Province, China.

Abstract

Aim: To investigate the feasibility of a SEMS (self-expandable metallic stent) as a bridge to surgery for malignant colonic obstruction.

Methods: We retrospectively reviewed 83 patients that were in accordance with inclusion criteria; of these, 33 patients that underwent fluoroscopy-guided SEMS placement followed by elective curative resection were classified as a SEMS group and 50 patients, who received emergency surgery (ES), were classified as an ES group. The clinicopathological characteristics, surgery-related parameters, complications, and three-year survival rate were compared between the two groups.

Results: No significant differences between the two groups were observed in any of the clinicopathologic characteristics except for higher preoperative absolute neutrophil count in the ES group (P < 0.001). Compared to the ES group, the SEMS group has significantly more cases, which featured a laparoscopic approach (72.7% vs. 14.0%, P < 0.001), lower overall stoma rate (0% vs. 34.0%, P < 0.001), and lower overall postoperative morbidity (27.3% vs. 56.0%, P=0.010). The oncological outcomes did not differ significantly between the two groups in terms of three-year overall survival (P=0.125). The technical and clinical success rates of stent placement were 91.7% and 100%, respectively.

Conclusion: Patients treated with the stent-surgery approach had significant short-term superiorities and similar long-term outcomes, compared to patients who had emergency surgery alone. The SEMS is, therefore, safe and feasible as a bridge to surgery for malignant colonic obstruction.