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Perioperative and oncologic outcomes of interval colectomy performed by acute care surgeons after stenting as a bridge to surgery for left-sided malignant colonic obstruction are non-inferior to the outcomes of colorectal surgeons in the elective setting: single center experience

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Abstract

Purpose

To analyze if perioperative and oncologic outcomes with stenting as a bridge to surgery (SEMS-BS) and interval colectomy performed by acute care surgeons for left-sided occlusive colonic neoplasms (LSCON) are non-inferior to those obtained by colorectal surgeons for non-occlusive tumors of the same location in the full-elective context.

Methods

From January 2011 to January 2021, patients with LSCON at University Regional Hospital in Málaga (Spain) were directed to a SEMS-BS strategy with an interval colectomy performed by acute care surgeons and included in the study group (SEMS-BS). The control group was formed with patients from the Colorectal Division elective surgical activity dataset, matching by ASA, stage, location and year of surgery on a ratio 1:2. Stages IV or palliative stenting were excluded. Software SPSS 23.0 was used to analyze perioperative and oncologic (defined by overall -OS- and disease free -DFS-survival) outcomes.

Results

SEMS-BS and control group included 56 and 98 patients, respectively. In SEMS-BS group, rates of technical/clinical failure and perforation were 5.35% (3/56), 3.57% (2/56) and 3.57% (2/56). Surgery was performed with a median interval time of 11 days (9–16). No differences between groups were observed in perioperative outcomes (laparoscopic approach, primary anastomosis rate, morbidity or mortality). As well, no statistically significant differences were observed in OS and DFS between groups, both compared globally (OS:p < 0.94; DFS:p < 0.67, respectively) or by stages I–II (OS:p < 0.78; DFS:p < 0.17) and III (OS:p < 0.86; DFS:p < 0.70).

Conclusion

Perioperative and oncologic outcomes of a strategy with SEMS-BS for LSCON are non-inferior to those obtained in the elective setting for non-occlusive neoplasms in the same location. Technical and oncologic safety of interval colectomy performed on a semi-scheduled situation by acute care surgeons is absolutely warranted.

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Abbreviations

CRC:

Colorectal cancer

LSCON:

Left-sided colonic occlusive neoplasms

SEMS:

Self-expandable metallic stent

ES:

Emergency surgery

RCT:

Randomized controlled trials

MA:

Meta-analysis

ACS:

Acute care surgery

CT:

Computed tomography

SEMS-BS:

Self-expandable metallic stent as a bridge to surgery

CRS:

Colorectal surgical activity database

OS:

Overall survival

DFS:

Disease-free survival

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Acknowledgements

To Dr. Di Saverio S. for previous exam of the paper, and so appreciable help with structure and language.

Funding

No funding was obtained to develop the present study.

Author information

Authors and Affiliations

  1. Trauma and Emergency Surgery Division, General, Digestive and Transplantation Surgery Department, University Regional Hospital, Malaga, Spain

    J. M. Aranda-Narváez, J. González-Cano, A. J. González-Sánchez, A. Titos-García, I. Cabrera-Serna & L. Romacho-López

  2. Colorectal Division, General, Digestive and Transplantation Surgery Department, University Regional Hospital, Malaga, Spain

    I. González-Poveda & S Mera-Velasco

  3. Endoscopy Division, Gastroenterology and Hepatology Department, University Regional Hospital, Malaga, Spain

    L. Vázquez-Pedreño

  4. Head-in-Chief. General, Digestive and Transplantation Surgery Department, University Regional Hospital, Malaga, Spain

    J. Santoyo-Santoyo

  5. Faculty of Medicine, Malaga University, Malaga, Spain

    J. M. Aranda-Narváez, J. González-Cano, A. J. González-Sánchez, A. Titos-García, I. Cabrera-Serna, L. Romacho-López, I. González-Poveda, S Mera-Velasco, L. Vázquez-Pedreño & J. Santoyo-Santoyo

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Contributions

AJM and GJ played the same role in designing the study, collecting/analyzing data and writing the manuscript. AJM, GAJ, TA, CI and RL performed colectomies in the study group and gave significant support to the final version of the manuscript. GI and MS operated patients of the control group and formulated adequate suggestions to analysis and writing. VL performed the endoscopic stent placement in most of the patients of study group and contributed with data regarding the procedure. SJ gave institutional support and key suggestions to the study and the manuscript. All authors have examined and approved the final version of this paper.

Corresponding author

Correspondence to J. M. Aranda-Narváez.

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Conflict of interests

The authors declare that they have no competing interests.

Ethics approval and consent to participate

The current study has received the approval of the Ethics for Investigation Committee of the province of Málaga, Spain (graphic confirmation available). No specific informed consent was considered necessary, though all patients signed the necessary consent for surgery.

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Aranda-Narváez, J., González-Cano, J., González-Sánchez, A. et al. Perioperative and oncologic outcomes of interval colectomy performed by acute care surgeons after stenting as a bridge to surgery for left-sided malignant colonic obstruction are non-inferior to the outcomes of colorectal surgeons in the elective setting: single center experience. Eur J Trauma Emerg Surg 48, 4651–4660 (2022). https://doi.org/10.1007/s00068-022-02015-9

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