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Quasi-elective left colectomy after endoscopic colon stenting for obstructive cancer yields comparable oncologic outcome to full-elective operation

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Whether deferring surgery after endoscopic self-expandable metal stent (SEMS) placement for neoplastic stricture, and operating patients in a quasi-elective situation, may result in similar oncologic outcomes to elective operations is unclear. This study aimed to evaluate the disease-free survival (DFS) rates of patients who underwent an interval colon resection after SEMS placement or an elective operation with comparable cancer stages.

Methods

From a prospective dataset, we retrospectively selected patients with the following characteristics: (1) left-sided colon cancer and (2) cancer stage I to III. Exclusion criteria were as follows: (1) palliative surgery and (2) emergency operation. Then we stratified patients into two groups: (A) full-elective left colon resection and (B) quasi-elective left colon resection, defined as surgery performed after SEMS placement for obstructive colon cancer. DFS function was studied by the Kaplan-Meier method.

Results

After 1:2 matching based on cancer stage, 106 patients of the group A were compared with 53 patients of group B. In each group, there were 9.4% of stage I, 39.4% of stage II, and 50.9% of stage III patients. The rate of technical failure in SEMS placement was 3.8%. After a mean follow-up of 54 months, 16 (15.1%) patients in the full-elective groups and 10 (18.9%) in the quasi-elective group experience cancer recurrence (log rank = 0.588). DFS curve did not reach the median value.

Conclusions

SEMS placement with interval colon resection for obstructive neoplastic strictures seems to provide similar long-term oncologic outcomes to operations performed in an elective setting when a low rate of technical failure is achieved.

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References

  1. Saida Y, Sumiyama Y, Nagao J, Uramatsu M (2003) Long-term prognosis of preoperative “bridge to surgery” expandable metallic stent insertion for obstructive colorectal cancer: comparison with emergency operation. Dis Colon Rectum 46(10 Suppl):S44–S49. https://doi.org/10.1097/01.DCR.0000087483.63718.A2

    Article  PubMed  Google Scholar 

  2. Ghazal A-HA, El-Shazly WG, Bessa SS, El-Riwini MT, Hussein AM (2013) Colonic endolumenal stenting devices and elective surgery versus emergency subtotal/total colectomy in the management of malignant obstructed left colon carcinoma. J Gastrointest Surg 17(6):1123–1129. https://doi.org/10.1007/s11605-013-2152-2

    Article  PubMed  Google Scholar 

  3. Arezzo A, Balague C, Targarona E, Borghi F, Giraudo G, Ghezzo L, Arroyo A, Sola-Vera J, de Paolis P, Bossotti M, Bannone E, Forcignanò E, Bonino MA, Passera R, Morino M (2017) Colonic stenting as a bridge to surgery versus emergency surgery for malignant colonic obstruction: results of a multicentre randomised controlled trial (ESCO trial). Surg Endosc 31(8):3297–3305. https://doi.org/10.1007/s00464-016-5362-3

    Article  PubMed  Google Scholar 

  4. Alcántara M, Serra-Aracil X, Falcó J, Mora L, Bombardó J, Navarro S (2011) Prospective, controlled, randomized study of intraoperative colonic lavage versus stent placement in obstructive left-sided colonic cancer. World J Surg 35:1904–1910. https://doi.org/10.1007/s00268-011-1139-y

    Article  PubMed  Google Scholar 

  5. Ho K-S, Quah H-M, Lim J-F, Tang C-L, Eu K-W (2012 Mar) Endoscopic stenting and elective surgery versus emergency surgery for left-sided malignant colonic obstruction: a prospective randomized trial. Int J Color Dis 27(3):355–362. https://doi.org/10.1007/s00384-011-1331-4

    Article  Google Scholar 

  6. Sloothaak DAM, van den Berg MW, Dijkgraaf MGW, Fockens P, Tanis PJ, van Hooft JE et al (2014) Oncological outcome of malignant colonic obstruction in the Dutch Stent-In 2 trial. Br J Surg 101:1751–1757. https://doi.org/10.1002/bjs.9645

    Article  PubMed  CAS  Google Scholar 

  7. Matsuda A, Miyashita M, Matsumoto S, Matsutani T, Sakurazawa N, Takahashi G, Kishi T, Uchida E (2015) Comparison of long-term outcomes of colonic stent as “bridge to surgery” and emergency surgery for malignant large-bowel obstruction: a meta-analysis. Ann Surg Oncol 22(2):497–504. https://doi.org/10.1245/s10434-014-3997-7

    Article  PubMed  Google Scholar 

  8. Cao Y, Gu J, Deng S, Li J, Wu K, Cai K (2019) Long-term tumour outcomes of self-expanding metal stents as “bridge to surgery” for the treatment of colorectal cancer with malignant obstruction: a systematic review and meta-analysis. Int J Color Dis 34:1827–1838. https://doi.org/10.1007/s00384-019-03372-5

    Article  Google Scholar 

  9. Ceresoli M, Allievi N, Coccolini F, Montori G, Fugazzola P, Pisano M et al (2017) Long-term oncologic outcomes of stent as a bridge to surgery versus emergency surgery in malignant left side colonic obstructions: a meta-analysis. J Gastrointest Oncol 8(5):867–876. https://doi.org/10.21037/jgo.2017.09.04

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kang SI, Oh H-K, Yoo JS, Ahn S, Kim MH, Kim MJ, Son IT, Kim DW, Kang SB, Park YS, Yoon CJ, Shin R, Heo SC, Lee IT, Youk EG, Kim MJ, Chang TY, Park SC, Sohn DK, Oh JH, Park JW, Ryoo SB, Jeong SY, Park KJ, Seoul Colorectal Group (SECOG) (2018) Oncologic outcomes of preoperative stent insertion first versus immediate surgery for obstructing left-sided colorectal cancer. Surg Oncol 27(2):216–224. https://doi.org/10.1016/j.suronc.2018.04.002

    Article  PubMed  Google Scholar 

  11. Park J, Lee HJ, Park SJ, Hur H, Min BS, Cheon JH et al (2018) Long-term outcomes after stenting as a bridge to surgery in patients with obstructing left-sided colorectal cancer. Int J Color Dis 33:799–807. https://doi.org/10.1007/s00384-018-3009-7

    Article  Google Scholar 

  12. Ho K-M, Chan K-M, Kwok S-Y, Lau PY-Y (2017) Colonic self-expanding metal stent (SEMS) as a bridge to surgery in left-sided malignant colonic obstruction: an 8-year review. Surg Endosc 31(5):2255–2262. https://doi.org/10.1007/s00464-016-5227-9

    Article  PubMed  Google Scholar 

  13. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP et al (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370(9596):1453–1457. https://doi.org/10.1016/S0140-6736(07)61602-X

    Article  Google Scholar 

  14. Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae

    Article  PubMed  PubMed Central  Google Scholar 

  15. Tejero E, Mainar A, Fernández L, Tobío R, De Gregorio MA (1994) New procedure for the treatment of colorectal neoplastic obstructions. Dis Colon Rectum 37(11):1158–1159. https://doi.org/10.1007/bf02049822

    Article  PubMed  CAS  Google Scholar 

  16. Martinez-Santos C, Lobato RF, Fradejas JM, Pinto I, Ortega-Deballón P, Moreno-Azcoita M (2002) Self-expandable stent before elective surgery vs. emergency surgery for the treatment of malignant colorectal obstructions: comparison of primary anastomosis and morbidity rates. Dis Colon Rectum 45:401–406. https://doi.org/10.1007/s10350-004-6190-4

    Article  PubMed  Google Scholar 

  17. Repici A, Conio M, Caronna S, De Angelis C, Costa CD, Morino M et al (2004) Early and late outcome of patients with obstructing colorectal cancer treated by stenting and elective surgery: a comparison with emergency surgery and patients operated without obstructive symptoms. Gastrointest Endosc 59:P275. https://doi.org/10.1016/s0016-5107(04)01217-9

    Article  Google Scholar 

  18. Ng KC, Law WL, Lee YM, Choi HK, Seto CL, Ho JWC (2006) Self-expanding metallic stent as a bridge to surgery versus emergency resection for obstructing left-sided colorectal cancer: a case-matched study. J Gastrointest Surg 10(6):798–803. https://doi.org/10.1016/j.gassur.2006.02.006

    Article  PubMed  Google Scholar 

  19. Atukorale YN, Church JL, Hoggan BL, Lambert RS, Gurgacz SL, Goodall S, Maddern GJ (2016) Self-expanding metallic stents for the management of emergency malignant large bowel obstruction: a systematic review. J Gastrointest Surg 20(2):455–462. https://doi.org/10.1007/s11605-015-2997-7

    Article  PubMed  Google Scholar 

  20. Arezzo A, Passera R, Lo Secco G, Verra M, Bonino MA, Targarona E et al (2017) Stent as bridge to surgery for left-sided malignant colonic obstruction reduces adverse events and stoma rate compared with emergency surgery: results of a systematic review and meta-analysis of randomized controlled trials. Gastrointest Endosc 86(3):416–426. https://doi.org/10.1016/j.gie.2017.03.1542

    Article  PubMed  Google Scholar 

  21. Nathan H, Yin H, Wong SL (2017) Postoperative complications and long-term survival after complex cancer resection. Ann Surg Oncol 24(3):638–644

    Article  PubMed  Google Scholar 

  22. Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P (2011) Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg 253:890–899

    Article  PubMed  Google Scholar 

  23. Artinyan A, Orcutt ST, Anaya DA et al (2015) Infectious postoperative complications decrease long-term survival in patients undergoing curative surgery for colorectal cancer: a study of 12,075 patients. Ann Surg 261:497–505

    Article  PubMed  Google Scholar 

  24. Nespoli A, Gianotti L, Totis M, Bovo G, Nespoli L, Chiodini P, Brivio F (2004) Correlation between postoperative infections and long-term survival after colorectal resection for cancer. Tumori. 90(5):485–490

    Article  PubMed  Google Scholar 

  25. Avlund TH, Erichsen R, Ravn S, Ciplys Z, Andersen JC, Laurberg S, Iversen LH (2018) The prognostic impact of bowel perforation following self-expanding metal stent as a bridge to surgery in colorectal cancer obstruction. Surg Endosc 32(1):328–336. https://doi.org/10.1007/s00464-017-5680-0

    Article  PubMed  Google Scholar 

  26. Gorissen KJ, Tuynman JB, Fryer E, Wang L, Uberoi R, Jones OM, Cunningham C, Lindsey I (2013) Local recurrence after stenting for obstructing left-sided colonic cancer. Br J Surg 100(13):1805–1809. https://doi.org/10.1002/bjs.9297

    Article  PubMed  CAS  Google Scholar 

  27. Maruthachalam K, Lash GE, Shenton BK, Horgan AF (2007) Tumour cell dissemination following endoscopic stent insertion. Br J Surg 94(9):1151–1154. https://doi.org/10.1002/bjs.5790

    Article  PubMed  CAS  Google Scholar 

  28. Yamashita S, Tanemura M, Sawada G, Moon J, Shimizu Y, Yamaguchi T, Kuwai T, Urata Y, Kuraoka K, Hatanaka N, Yamashita Y, Taniyama K (2018) Impact of endoscopic stent insertion on detection of viable circulating tumor cells from obstructive colorectal cancer. Oncol Lett 15(1):400–406. https://doi.org/10.3892/ol.2017.7339

    Article  PubMed  CAS  Google Scholar 

  29. Amelung FJ, Borstlap WAA, Consten ECJ, Veld JV, van Halsema EE, Bemelman WA, Siersema PD, ter Borg F, van Hooft J, Tanis PJ, Dutch Snapshot Research Group (2019) Propensity score-matched analysis of oncological outcome between stent as bridge to surgery and emergency resection in patients with malignant left-sided colonic obstruction. Br J Surg 106(8):1075–1086. https://doi.org/10.1002/bjs.11172

    Article  PubMed  CAS  Google Scholar 

  30. Lara-Romero C, Vilches Á, Caunedo-Álvarez Á, Hergueta-Delgado P, Lavín-Castejón I, Andrade-Bellido R, Alcaín-Martínez G (2019) Better recurrence-free survival after stent bridge to surgery compared to emergency surgery for obstructive left-sided colonic cancer in patients with stage III status of the American Joint Committee on Cancer (AJCC): a bicentric retrospective study. Int J Color Dis 34(7):1241–1250. https://doi.org/10.1007/s00384-019-03318-x

    Article  Google Scholar 

  31. Gianotti L, Tamini N, Nespoli L, Rota M, Bolzonaro E, Frego R, Redaelli A, Antolini L, Ardito A, Nespoli A, Dinelli M (2013) A prospective evaluation of short-term and long-term results from colonic stenting for palliation or as a bridge to elective operation versus immediate surgery for large-bowel obstruction. Surg Endosc 27(3):832–842. https://doi.org/10.1007/s00464-012-2520-0

    Article  PubMed  Google Scholar 

  32. Kim JS, Hur H, Min BS, Sohn SK, Cho CH, Kim NK (2009) Oncologic outcomes of self-expanding metallic stent insertion as a bridge to surgery in the management of left-sided colon cancer obstruction: comparison with nonobstructing elective surgery. World J Surg 33(6):1281–1286. https://doi.org/10.1007/s00268-009-0007-5

    Article  PubMed  Google Scholar 

  33. Knight AL, Trompetas V, Saunders MP, Anderson HJ (2012) Does stenting of left-sided colorectal cancer as a “bridge to surgery” adversely affect oncological outcomes? A comparison with non-obstructing elective left-sided colonic resections. Int J Color Dis 27(11):1509–1514. https://doi.org/10.1007/s00384-012-1513-8

    Article  Google Scholar 

  34. Kulaylat AS, Pappou E, Philp MM, Kuritzkes BA, Ortenzi G, Hollenbeak CS, Choi C, Messaris E (2019) Emergent colon resections: does surgeon specialization influence outcomes? Dis Colon Rectum 62(1):79–87. https://doi.org/10.1097/DCR.0000000000001230

    Article  PubMed  Google Scholar 

  35. Goldstone RN, Cauley CE, Chang DC, Kunitake H, Ricciardi R, Bordeianou L (2019) The effect of surgical training and operative approach on outcomes in acute diverticulitis: should guidelines be revised? Dis Colon Rectum 62(1):71–78. https://doi.org/10.1097/DCR.0000000000001240

    Article  PubMed  Google Scholar 

  36. van Hooft JE, van Halsema EE, Vanbiervliet G, Beets-Tan RGH, DeWitt JM, Donnellan F et al (2014) Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Gastrointest Endosc 80(5):747–61.e1–75

    Article  PubMed  Google Scholar 

  37. Matsuda A, Miyashita M, Matsumoto S, Sakurazawa N, Takahashi G, Matsutani T, Yamada M, Uchida E (2016) Comparison between metallic stent and transanal decompression tube for malignant large-bowel obstruction. J Surg Res 205(2):474–481. https://doi.org/10.1016/j.jss.2016.04.055

    Article  PubMed  Google Scholar 

  38. Robinson AG, Booth CM, Eisenhauer EA (2014) Disease-free survival as an end-point in the treatment of solid tumours – Perspectives from clinical trials and clinical practice. Eur J Cancer 50:2298–2302. https://doi.org/10.1016/j.ejca.2014.05.016

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Surgery, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy

    Nicolò Tamini, Luca Nespoli, Marco Braga & Luca Gianotti

  2. School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy

    Marco Ceresoli, Simone Aldè, Francesca Carissimi, Lorenzo Ripamonti, Luca Nespoli, Marco Braga & Luca Gianotti

  3. Endoscopy Unit, San Gerardo Hospital, Monza, Italy

    Marco Dinelli

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  1. Nicolò Tamini
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  2. Marco Ceresoli
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  3. Simone Aldè
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  4. Francesca Carissimi
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Contributions

Conception and design: NT, MC, SA, LG

Analysis and interpretation of the data: NT, MC, SA, FC, LR, LN, MD, MB, LG

Drafting of the article: NT, MC, FC, LR, LG

Critical revision of the article for important intellectual content: NT, MC, SA, FC, LR, LN, MD, MB, LG

Final approval of the article: NT, MC, SA, FC, LR, LN, MD, MB, LG

Corresponding author

Correspondence to Luca Gianotti.

Ethics declarations

The study protocol followed the ethical guidelines of the 1975 Declaration of Helsinki (as revised in Brazil 2013). The local Ethical Committee review of the protocol deemed that formal approval was not required owing to the retrospective, observational, and anonymous nature of this study.

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The authors declare that they have no conflict of interest.

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Tamini, N., Ceresoli, M., Aldè, S. et al. Quasi-elective left colectomy after endoscopic colon stenting for obstructive cancer yields comparable oncologic outcome to full-elective operation. Int J Colorectal Dis 35, 633–640 (2020). https://doi.org/10.1007/s00384-020-03519-9

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