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Self-expandable metallic stent as a bridge to elective surgery versus emergency surgery for acute malignant colorectal obstruction

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Abstract

Backgroud

The efficacy and safety of self-expandable metallic stents (SEMSs) as a bridge for patients with acute malignant colorectal obstructions (AMCOs) are still controversial. We conducted this study to evaluate the outcomes of patients with AMCOs treated by different strategies.

Methods

From January 2010 to March 2014, a total of 171 patients with AMCOs from Zhongshan Hospital were retrospectively enrolled in this study. One hundred twenty patients successfully received stent placement followed by one-stage laparoscopic or open resection in the stent group, and 51 patients received emergency operations in the emergency group.

Results

The operation duration and postoperative hospital stay were significantly shorter in the stent group (114.51 ± 28.65 vs. 160.39 ± 58.94 min, P < 0.001; 8.00 ± 3.97 vs. 12.59 ± 9.07 days, P = 0.001). The stent group also had significantly reduced intraoperative blood loss and the incidence of postoperative complications compared with the emergency group (61.00 ± 43.70 vs. 121.18 ± 85.90 ml, P < 0.001; 16.7 vs. 37.3 %, P = 0.003). Kaplan–Meier survival curves showed that the median survival time in the stent group was significantly longer than that in the emergency group (53 vs. 41 months, P = 0.034). In subgroup analysis of stent group, the stent laparoscopy group had significantly decreased postoperative complications (P = 0.025), and similar long-term survival (P = 0.81).

Conclusions

Stent placement as a bridge to surgery is a safe and feasible procedure and provides significant advantages in terms of short-term outcomes and favorable prognoses for patients with AMCOs. Laparoscopic surgery could be considered as an optimal treatment after stent placement.

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Acknowledgments

At the point of finishing this paper, first of all, we gratefully acknowledge the help of our supervisor professors. We thank Ye Wei, who has offered us valuable suggestions in the academic studies and has tried his best to improve our paper. Our sincere thanks are also given to Prof. Jian-Min Xu and Prof. Wen-Ju Chang from whose help we benefited greatly. In addition, we would like to express our gratitude to all those who have lent us hands during the writing of this paper. Finally, we thank the American Journal Experts (AJE) for proofreading for English grammar and spelling.

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    Authors and Affiliations

    1. Department of Gastrointestinal Surgery, The First Hospital of Putian, Fu Jian, 351100, China

      Zhi-Xiong Li

    2. Department of General Surgery, The First Hospital of Nan Ping, Fu Jian, 353000, China

      Xiao-Hua Wu

    3. Department of Pathology, The First Hospital of Putian, Fu Jian, 351100, China

      Hai-yan Wu

    4. Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China

      Wen-Ju Chang, Tuo Yi, Jing-Wen Chen, Qing-Yang Feng, De-Xiang Zhu, Ye Wei & Jian-Min Xu

    5. Department of Endoscopic Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China

      Qiang Shi & Yun-Shi Zhong

    6. Center for Therapeutic Research of Hepatocarcinoma, Beijing 302 Hospital, Beijing, 100000, China

      Xiu-juan Chang

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    Correspondence to Ye Wei or Yun-Shi Zhong.

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    Zhi-Xiong Li, Xiao-Hua Wu, Hai-yan Wu, Wen-Ju Chang, Xiu-Juan Chang, Tuo Yi, Qiang Shi, Jing-Wen Chen, Qing-Yang Feng, De-Xiang Zhu, Ye Wei, Yun-Shi Zhong, and Jian-Min Xu have no conflicts of interest or financial ties to disclose.

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    Zhi-Xiong Li, Xiao-Hua Wu, Hai-yan Wu, and Jian-Min Xu should be considered as first co-authors.

    Zhi-Xiong Li, Xiao-Hua Wu, Hai-yan Wu and Jian-Min Xu contributed equally to this work.

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    Li, ZX., Wu, XH., Wu, Hy. et al. Self-expandable metallic stent as a bridge to elective surgery versus emergency surgery for acute malignant colorectal obstruction. Int J Colorectal Dis 31, 561–570 (2016). https://doi.org/10.1007/s00384-015-2476-3

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