Bridge‐to‐surgery stent placement versus emergency surgery for acute malignant colonic obstruction. Issue 7 (16th April 2014)

• Record Type: Journal Article
• Authors: van den Berg, M. W.; Sloothaak, D. A. M.; Dijkgraaf, M. G. W.; van der Zaag, E. S.; Bemelman, W. A.; Tanis, P. J.; Bosker, R. J. I.; Fockens, P.; ter Borg, F.; van Hooft, J. E.
• Is Part Of: British journal of surgery. Volume 101:Issue 7(2014:Jul.)
• Page Start: 867
• Page End: 873
• Publication Date: 2014-04-16
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1002/bjs.9521
• Languages: English
• ISSNs: 0007-1323

Abstract

<abstract abstract-type="main" id="bjs9521-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bjs9521-sec-0001" sec-type="section"> <title>Background</title> <p id="bjs9521-para-0001">Endoscopic self‐expanding metal stent (SEMS) placement as a bridge to surgery is an option for acute malignant colonic obstruction. There is ongoing debate regarding the superiority and oncological safety of SEMS placement compared with emergency surgery. This retrospective study aimed to compare outcomes of these treatment approaches.</p> </sec> <sec id="bjs9521-sec-0002" sec-type="section"> <title>Methods</title> <p id="bjs9521-para-0002">Patients were identified from cohorts treated between 2005 and 2012 in two teaching hospitals, of which one used emergency surgery only in patients with large bowel obstruction, whereas the other attempted SEMS placement. Only patients treated with curative intent were included.</p> </sec> <sec id="bjs9521-sec-0003" sec-type="section"> <title>Results</title> <p id="bjs9521-para-0003">The study included 59 patients in whom SEMS placement was attempted and 51 who underwent surgery alone. The successful primary anastomosis rate was higher in the SEMS group than in the surgery‐alone group among patients with left‐sided obstruction (30 of 43 <italic>versus</italic> 10 of 34 respectively; <italic>P</italic> = 0·001), whereas stoma formation was less common (11 of 43 <italic>versus</italic> 23 of 34; <italic>P</italic> < 0·001). Such differences were not apparent in patients with right‐sided obstruction. Secondary stoma rates were comparable between treatment approaches (left‐sided: 11 of 43 <italic>versus</italic> 13 of 34, <italic>P =</italic> 0·322; right‐sided: 1 of 16 <italic>versus</italic> 1 of 17, <italic>P =</italic> 1·000). There were no significant differences in morbidity, mortality, recurrence or survival.</p> </sec> <sec id="bjs9521-sec-0004" sec-type="section"> <title>Conclusion</title> <p id="bjs9521-para-0004">Endoscopic SEMS placement increased the primary anastomosis rate in patients with left‐sided large bowel obstruction.</p> </sec> </abstract>