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Long-term outcomes after stenting as a bridge to surgery in patients with obstructing left-sided colorectal cancer

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Abstract

Purpose

Self-expandable metallic stents (SEMS) may be used in acute, obstructing, left-sided colorectal cancer (CRC) to avoid high-risk emergency surgery. However, the data regarding the long-term effects of SEMS as a bridge to surgery are limited and contradictory. Our aim is to analyze the long-term oncological outcomes of SEMS compared with surgery.

Methods

Between January 2006 and November 2013, a total of 855 patients with stage III CRC were regularly followed at the CRC clinic of Severance Hospital, Seoul, Korea. We retrospectively evaluated their 5-year disease-free survival (DFS), 5-year overall survival (OS), and 5-year cancer-specific survival (CSS).

Results

There were 94 patients in the SEMS group, 17 in the emergent-surgery group, and 744 in the elective-surgery group. In the short term, the rate of permanent stoma formation was significantly higher in the emergent-surgery group than in the SEMS group (p = 0.030), although the median hospital stay and overall complication rate were comparable. During the long-term follow-up period, oncological outcomes including 5-year DFS (70.2 vs 52.9%; p = 0.210), OS (70.2 vs 52.9%; p = 0.148), and CSS (79.8 vs 70.6%; p = 0.342) were not different between the SEMS group and the emergent-surgery group. Multivariate analysis showed emergent operation to be a significant risk factor of DFS (hazard ratio [HR], 3.117; 95% confidence interval [CI], 1.498–6.489; p = 0.002).

Conclusions

Preoperative SEMS insertion does not adversely affect long-term oncological outcomes or patient survival.

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Acknowledgements

The authors thank native English-speaking experts from BioMed Proofreading® LLC for the editing.

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Authors and Affiliations

  1. Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea

    Jihye Park, Hyun Jung Lee, Soo Jung Park, Jae Hee Cheon, Tae Il Kim & Won Ho Kim

  2. Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea

    Hyun Jung Lee

  3. Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea

    Hyuk Hur, Byung Soh Min & Nam Kyu Kim

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  1. Jihye Park
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Correspondence to Hyun Jung Lee.

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Informed consent was obtained from all patients before the procedure. This study was approved by the institutional review board of Severance Hospital, Yonsei University (Seoul, Korea) and was conducted in accordance with the ethical principles of the Declaration of Helsinki

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

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