Outcomes of self-expandable metal stent as bridge to surgery versus emergency surgery for left-sided obstructing colon cancer: A retrospective cohort study

Am J Surg. 2021 Jan;221(1):168-173. doi: 10.1016/j.amjsurg.2020.06.012. Epub 2020 Jun 14.

Abstract

Background: Long-term outcomes of self-expandable metal stents (SEMSs) as bridges to surgery versus emergency surgery in the treatment of left-sided obstructing colon cancer remain unclear.

Methods: Using a nationwide inpatient database in Japan, we performed one-to-one propensity score matching to compare overall survival, the stoma requirement, postoperative complications, and the length of stay between the SEMS and emergency surgery groups.

Results: Compared with the emergency surgery group, the SEMS group showed worse survival (hazard ratio, 1.80; 95% confidence interval, 1.07-3.01), a higher incidence of postoperative ileus (8% vs. 4%, P = 0.010), a longer postoperative length of stay (14 vs. 12 days, P < 0.001), and a lower stoma requirement (10% vs. 29%, P < 0.001).

Conclusions: SEMSs as bridges to surgery are associated with significantly poorer overall survival, a higher incidence of postoperative ileus, a longer length of stay, and a lower stoma requirement than is emergency surgery.

Keywords: Colon stent; Obstructing colon cancer; Overall survival; Propensity score.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Colonic Neoplasms / complications*
  • Colonic Neoplasms / mortality
  • Colonic Neoplasms / surgery*
  • Emergency Treatment
  • Female
  • Humans
  • Intestinal Obstruction / etiology*
  • Intestinal Obstruction / mortality
  • Intestinal Obstruction / surgery*
  • Male
  • Middle Aged
  • Postoperative Complications
  • Preoperative Period
  • Propensity Score
  • Retrospective Studies
  • Self Expandable Metallic Stents*
  • Survival Rate
  • Treatment Outcome