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Annals of Surgical Oncology

, Volume 24, Issue 6, pp 1618–1625 | Cite as

Endoscopic Stenting Does Not Worsen Long Term Outcomes Amongst Patients Presenting with Obstruction from Colorectal Cancers

  • Tian-Zhi Lim
  • Dedrick Kok Hong Chan
  • Ker-Kan TanEmail author
Colorectal Cancer

Abstract

Background

Stenting has been increasingly adopted in colorectal cancer patients presenting with acute large bowel obstruction. However, long-term outcomes of stenting are lacking in the literature. Our study attempts to compare the long-term outcomes of colonic stenting and emergency surgery amongst left-sided colorectal cancer patients presenting with acute large bowel obstruction.

Methods

A retrospective review of all patients who presented with nonmetastatic colorectal cancer who underwent either endoscopic stenting or emergency surgery for acute large bowel obstruction was performed from January 2007 to April 2016. Patients were analysed in an intention-to-treat analysis.

Results

Forty-seven (46.1%) patients underwent emergency surgery, whereas 55 (53.9%) underwent colonic stenting with a technical success rate of 71.0%. Patients who underwent emergency surgery were more likely to develop severe complications compared with patients who underwent successful colonic stenting, but the difference was not statistically significant (odds ratio [OR] 2.84; 95% confidence interval [CI] 0.71–11.3, p = 0.139). Patients were followed up for a median of 48.3 months (3.1–111) in the stenting group and 51.2 months (1.2–117.1) in the emergency surgery group. Recurrence rates between colonic stenting and emergency surgery were similar (25.6% vs. 21.3%, p = 0.500), with more anastomotic and peritoneal recurrences were noted in the emergency surgery group. 5 year disease free survival (77% vs. 73%, p = 0.708) and overall survival (86% vs. 62%, p = 0.064) also were similar.

Conclusions

Patients who underwent endoscopic stenting for large bowel obstruction have comparable long-term outcomes as those who undergo emergency surgery. The role of endoscopic stenting in obstructed colorectal cancers merits further evaluation.

Keywords

Emergency Surgery Technical Success Peritoneal Recurrence Undergo Emergency Surgery Endoscopic Stenting 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

All authors have obtained no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work, and no other relationships or activities that could appear to have influenced the submitted work.

Disclosure

The authors disclose no conflicts.

Supplementary material

10434_2016_5724_MOESM1_ESM.docx (12 kb)
Supplementary material 1 (DOCX 11 kb)

References

  1. 1.
    Ye GY, Cui Z, Chen L, Zhong M. Colonic stenting vs emergent surgery for acute left sided malignant colonic obstruction: a systemic review and meta-analysis. World J Gastroenterol. 2012;18(39):5608–15.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Sagar J. Colorectal stents for the management of malignant colonic obstructions. Cochrane Database Syst Rev. 2001. doi: 10.1002/14651858.CD007378.pub2.Google Scholar
  3. 3.
    Barillari P, Aurello P, De Angelis R, Valabrega S, Ramacciato G, D’Angelo F, et al. Management and survival of patients affected with obstructive colorectal cancer. Int Surg. 1992;77(4):251–5.PubMedGoogle Scholar
  4. 4.
    Padwick RT, Chauhan V, Newman M, Francombe J, Osborne MJ. Endoscopic stenting of acutely obstructing colorectal cancer: a 10-year review from a tertiary referral centre. ANZ J Surg. 2016;86(10):778–81.CrossRefPubMedGoogle Scholar
  5. 5.
    Nichols TR. Health-related quality of life in community-dwelling persons with ostomies: the physical functioning domain. J Wound Ostomy Continence Nurs. 2015;42(4):374–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Lim TZ, Chan D, Tan KK. Patients who failed endoscopic stenting for left-sided malignant colorectal obstruction suffered the worst outcomes. Int J Colorectal Dis. 2014;29(10):1267–73.CrossRefPubMedGoogle Scholar
  7. 7.
    van Halsema EE, van Hooft JE, Small AJ, Baron TH, García-Cano J, Cheon JH, et al. Perforation in colorectal stenting: a meta-analysis and a search for risk factors. Gastrointest Endosc. 2014;79(6):970.e7–82.e7.Google Scholar
  8. 8.
    Fryer E, Gorissen KJ, Wang LM, Guy R, Chetty R. Spectrum of histopathological changes encountered in stented colorectal carcinomas. Histopathology. 2015;66(4):480–4.CrossRefPubMedGoogle Scholar
  9. 9.
    Sloothaak DAM, van den Berg MW, Dijkgraaf MGW, Fockens P, Tanis PJ, van Hooft JE, et al. Oncological outcome of malignant colonic obstruction in the Dutch Stent-In 2 trial. Br J Surg. 2014;101:1751–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Gorissen KJ, Tuynman JB, Fryer E, Wang L, Uberoi R, Jones OM, et al. Local recurrence after stenting for obstructing left-sided colonic cancer. BJS. 2013;100:1805–9.CrossRefGoogle Scholar
  11. 11.
    Kavanagh DO, Nolan B, Judge C, Hyland, J, Mulcahy, HE, O’Connell, PR, et al. A comparative study of short and medium term outcomes comparing emergent surgery and stenting as a bridge to surgery in patients with acute malignant colonic obstruction. Dis Colon Rectum. 2013;56(4):433–40.CrossRefPubMedGoogle Scholar
  12. 12.
    Clavien PA, Sanabria JR, Mentha G, Borst F, Buhler L, Roche B, et al. Recent results of elective open cholecystectomy in a North American and a European center: comparison of complications and risk factors. Ann Surg. 1992;216(6):618–26.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Clavien PA, Camargo CA Jr, Croxford R, Langer B, Levy GA, Greig PD. Definition and classification of negative outcomes in solid organ transplantation: application in liver transplantation. Ann Surg. 1994;220(2):109–20.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    American Gastroenterology Association. AGA institute guidelines for colonoscopy surveillance after cancer resection: clinical decision tool. Gastroenterology. 2014;146(5):1413–4.CrossRefGoogle Scholar
  16. 16.
    Alcántara M, Serra-Aracil X, Falcó J, Mora L, Bombardó J, Navarro S. Prospective, controlled, randomized study of intraoperative colonic lavage versus stent placement in obstructive left-sided colonic cancer. World J Surg. 2011;35(8):1904–10.CrossRefPubMedGoogle Scholar
  17. 17.
    Tung KL, Cheung HY, Ng LW, Chung CC, Li MK. Endo-laparoscopic approach versus conventional open surgery in the treatment of obstructing left-sided colon cancer: long-term follow-up of a randomized trial. Asian J Endosc Surg. 2013;6(2):78–81.CrossRefPubMedGoogle Scholar
  18. 18.
    Sabbagh C, Chatelain D, Trouillet N, Mauvais F, Bendjaballah S, Browet F, 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(10):3622–31.CrossRefPubMedGoogle Scholar
  19. 19.
    Maruthachalam K, Lash GE, Shenton BK, Horgan AF. Tumour cell dissemination following endoscopic stent insertion. Br J Surg. 2007;94(9):1151–4.CrossRefPubMedGoogle Scholar
  20. 20.
    Lacy AM, García-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet. 2002;359:2224–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004;350:2050–9.CrossRefGoogle Scholar
  22. 22.
    Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005;365:1718–26.CrossRefPubMedGoogle Scholar
  23. 23.
    van Hooft JE, van Halsema EE, Vanbiervliet G, Beets-Tan RG, DeWitt JM, Donnellan F, et al. Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Gastrointest Endosc. 2014;80(5):747–61.e1-75.Google Scholar
  24. 24.
    Kim JH, Kwon KA, Lee JJ, Lee WS, Baek JH, Kim YJ, et al. Surgical failure after colonic stenting as a bridge to surgery. World J Gastroenterol. 2014;20(33):11826–34.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    AbdussametBozkurt M, Gonenc M, Kapan S, Kocatasş A, Temizgönül B, Alis H. Colonic stent as bridge to surgery in patients with obstructive left-sided colon cancer. JSLS. 2014;18(4), 1086–8089.CrossRefGoogle Scholar
  26. 26.
    Koh FH, Wong J, Tan JK, Tan KK, Cheong WK, Lieske B. Laparoscopic colorectal surgery is safe and benefits octogenarian patients with malignant disease: a matched case-control study comparing laparoscopic and open colorectal surgery. Int J Colorectal Dis. 2015;30(7):963–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Rinaldi L, Ouaissi M, Barabino G, Loundou A, Clavel L, Sielezneff I, et al. Laparoscopy could be the best approach to treat colorectal cancer in selected patients aged over 80 years: outcomes from a multicenter study. Dig Liver Dis. 2016. doi: 10.1016/j.dld.2016.06.039.PubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Tian-Zhi Lim
    • 1
  • Dedrick Kok Hong Chan
    • 1
  • Ker-Kan Tan
    • 1
    • 2
    Email author
  1. 1.Division of Colorectal Surgery, University Surgical ClusterNational University Health SystemSingaporeSingapore
  2. 2.Department of Surgery, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore

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