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Comparison of Long-Term Outcomes Between Emergency Surgery and Bridge to Surgery for Malignant Obstruction in Right-Sided Colon Cancer: A Multicenter Retrospective Study

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Malignant obstruction in right-sided colon (MORC) has traditionally been treated by emergency resection with primary anastomosis. The aim of this study was to evaluate short-term postoperative and long-term oncologic outcomes according to the surgical approach adopted for MORC.

Methods

A total of 1785 patients who underwent curative surgery for stage II or III colon cancer in seven hospitals were reviewed retrospectively. Seventy-four of 1785 patients had MORC. We compared the postoperative outcome and long-term oncologic outcome between the emergency surgery (ES) group (49 patients) and the bridge to surgery (BS) group (25 patients) for 74 patients with MORC.

Results

There were no differences in the length of the distal and proximal resection margin (p = 0.820 and p = 0.620) or the number of metastatic lymph nodes (p = 0.221). There were no differences in flatus passage (p = 0.242), start of diet (p = 0.336), hospital stay (p = 0.444), or postoperative morbidity (p = 0.762). The 5-year overall survival rates were 73.2 % in the ES group and 90.7 % in the BS group (p = 0.172). Moreover, the 5-year disease-free survival rates were 71.9 % in the ES group and 76.2 % in the BS group (p = 0.929).

Conclusions

On the basis of the above results, the postoperative course of the ES group was similar to that of the BS group. In addition, the long-term oncologic outcome of the BS group was similar or slightly better than that of the ES group. BS after colonic stent may be an alternative option for MORC.

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References

  1. Ohman U. Prognosis in patients with obstructing colorectal carcinoma. Am J Surg. 1982;143:742–7.

    Article  CAS  PubMed  Google Scholar 

  2. Setti Carraro PG, Segala M, Cesana B, Tiberio G. Obstructing colonic cancer: failure and survival patterns over a ten-year follow-up after one-stage curative surgery. Dis Colon Rectum. 2001;44:243–50.

  3. Carty N, Corder AP. Which surgeons avoid a stoma in treating left-sided colonic obstruction? Results of a postal questionnaire. Ann Coll Surg Engl. 1992;74:391–4.

    CAS  Google Scholar 

  4. Fielding LP, Wells BW. Survival after primary and staged resection for large bowel obstruction caused by cancer. Br J Surg. 1974;61:16–8.

    Article  CAS  PubMed  Google Scholar 

  5. Phillips RKS, Hittinger R, Fry JS, Fielding LP. Malignant large bowel obstruction. Br J Surg. 1985;72:296–302.

    Article  CAS  PubMed  Google Scholar 

  6. Repici A, Adler DG, Gibbs CM, et al. Stenting of the proximal colon in patients with malignant large bowel obstruction: techniques and outcomes. Gastrointest Endosc. 2007;66:940–4.

    Article  PubMed  Google Scholar 

  7. Tekkis PP, Kinsman R, Thompson MR, Stamatakis JD. The Association of Coloproctology of Great Britain and Ireland study of large bowel obstruction caused by colorectal cancer. Ann Surg. 2004;240:76–81.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Hsu TC. Comparison of one-stage resection and anastomosis of acute complete obstruction of left and right colon. Am J Surg. 2005;189:384–7.

    Article  PubMed  Google Scholar 

  9. Campbell KL, Hussey JK, Eremin O. Expandable metal stent application in obstructing carcinoma of the proximal colon: report of a case. Dis Colon Rectum. 1997;40:1391–3.

    Article  CAS  PubMed  Google Scholar 

  10. Balague C, Targarona EM, Sainz S, et al. Minimally invasive treatment for obstructive tumors of the left colon: endoluminal self-expanding metal stent and laparoscopic colectomy: preliminary results. Dig Surg. 2004;21:282–6.

    Article  PubMed  Google Scholar 

  11. Cho YK, Kim SW, Lee BI, et al. Clinical outcome of self-expandable metal stent placement in the management of malignant proximal colon obstruction. Gut Liver. 2011;5:165–70.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Stimac D. Colonic stents for the palliation of malignant colonic obstruction. Dig Dis. 2008;26:336–41.

    Article  PubMed  Google Scholar 

  13. Bhardwaj R, Parker MC. Palliative therapy of colorectal carcinoma: stent or surgery? Colorectal Dis. 2003;5:518–21.

    Article  CAS  PubMed  Google Scholar 

  14. Maruthachalam K, Lash GE, Shenton BK, Horgan AF. Tumour cell dissemination following endoscopic stent insertion. Br J Surg. 2007;94:1151–4.

    Article  CAS  PubMed  Google Scholar 

  15. Steinert EM, Schwartz RH, Singh NJ. At low precursor frequencies, the T-cell response to chronic self-antigen results in anergy without deletion. Eur J Immunol. 2012;42:2875–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Sabbagh C, Chatelain D, Trouillet N, et al. Does use of a metallic colon stent as a bridge to surgery modify the pathology data in patients with colonic obstruction? A case-matched study. Surg Endosc. 2013;27:3622–31.

    Article  PubMed  Google Scholar 

  17. Kim HJ, Choi GS, Park JS, et al. Higher rate of perineural invasion in stent-laparoscopic approach in comparison to emergent open resection for obstructing left-sided colon cancer. Int J Colorectal Dis. 2013;28:407–14.

    Article  PubMed  Google Scholar 

  18. Saida Y, Sumiyama Y, Nagao J, Uramatsu M. Long-term prognosis of preoperative “bridge to surgery” expandable metallic stent insertion for obstructive colorectal cancer: comparison with emergency operation. Dis Colon Rectum. 2003;46(10 suppl):S44–9.

    PubMed  Google Scholar 

  19. Kim JS, Hur H, Min BS, et al. 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. 2009;33:1281–6.

    Article  PubMed  Google Scholar 

  20. Choi JM, Lee C, Han YM, et al. Long-term oncologic outcomes of endoscopic stenting as a bridge to surgery for malignant colonic obstruction: comparison with emergency surgery. Surg Endosc. 2014;28:2649–55.

    Article  PubMed  Google Scholar 

  21. Sabbagh C, Browet F, Diouf M, et al. Is stenting as a “bridge to surgery” an oncologically safe strategy for the management of acute, left-sided, malignant, colonic obstruction? A comparative study with a propensity score analysis. Ann Surg. 2013;258:107–15.

    Article  PubMed  Google Scholar 

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Acknowledgment

We thank Jae Im Lee, Byoung-Jo Choi, Ji-Hoon Kim, and other colleagues who helped with data collection in the colorectal division of the Surgery Department from The Catholic University of Korea.

Disclosure

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea

    Bong-Hyeon Kye MD, Hyeon-Min Cho MD & Hyung-Jin Kim MD

  2. Department of Surgery, Inchon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Inchon, South Korea

    Yoon Suk Lee MD

  3. Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea

    Jun-Gi Kim MD, Seong-Taek Oh MD & In Kyu Lee MD

  4. Department of Surgery, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea

    Won Kyung Kang MD

  5. Department of Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, South Korea

    Chang-Hyeok Ahn MD

  6. Department of Surgery, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, South Korea

    Sang Chul Lee MD

  7. Department of Surgery, Saint Paul’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea

    Jong-Kyung Park MD

Authors
  1. Bong-Hyeon Kye MD
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  2. Yoon Suk Lee MD
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  3. Hyeon-Min Cho MD
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  4. Jun-Gi Kim MD
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  5. Seong-Taek Oh MD
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  6. In Kyu Lee MD
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  7. Won Kyung Kang MD
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  8. Chang-Hyeok Ahn MD
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  9. Sang Chul Lee MD
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  10. Jong-Kyung Park MD
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  11. Hyung-Jin Kim MD
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Corresponding author

Correspondence to Hyung-Jin Kim MD.

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Kye, BH., Lee, Y.S., Cho, HM. et al. Comparison of Long-Term Outcomes Between Emergency Surgery and Bridge to Surgery for Malignant Obstruction in Right-Sided Colon Cancer: A Multicenter Retrospective Study. Ann Surg Oncol 23, 1867–1874 (2016). https://doi.org/10.1245/s10434-015-5053-7

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  • DOI: https://doi.org/10.1245/s10434-015-5053-7

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