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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

 Jin Soo Kim  ;  Hyuk Hur  ;  Byung Soh Min  ;  Seung Kook Sohn  ;  Chang Hwan Cho  ;  Nam Kyu Kim 
 WORLD JOURNAL OF SURGERY, Vol.33(6) : 1281-1286, 2009 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Colorectal Neoplasms/complications ; Colorectal Neoplasms/mortality ; Colorectal Neoplasms/surgery* ; Disease-Free Survival ; Elective Surgical Procedures* ; Female ; Humans ; Intestinal Obstruction/etiology ; Intestinal Obstruction/surgery* ; Male ; Middle Aged ; Stents* ; Survival Rate ; Treatment Outcome ; Young Adult
Oncologic Outcome ; Stent Insertion ; Stent Group ; Colonic Obstruction ; SEMS Placement
BACKGROUND: Self-expanding metallic stents (SEMS) have been used as a bridge to surgery in patients with obstruction by colorectal cancer, but the oncologic safety of this technique has not yet been established. The aim of the present study was to compare the outcomes of bridge to surgery after SEMS insertion and nonobstructing elective surgery.

METHODS: Between October 1999 and July 2007, 35 patients who had left-sided colon malignancy obstruction and underwent surgical resection after SEMS insertion (group A) were matched to 350 patients who underwent elective surgery for nonobstructing left-sided colon cancer based on stage II, III, and IV malignancies according to the 2001 American Joint Committee on Cancer (group B). Group B was randomly extracted from the colorectal database of our institute. The two groups were compared for clinicopathologic variables, complications, and survival rate.

RESULTS: There were no significant differences in clinicopathologic variables between group A and group B. However, the stoma formation rate was statistically different between the two groups (p = 0.003). Self-expanding metallic stent insertion had an adverse effect on the 5-year overall survival rate (A vs. B, 38.4% vs. 65.6%, respectively; p = 0.025) and the 5-year disease-free survival rate (A vs. B, 48.3% vs. 75.5%, respectively; p = 0.024).

CONCLUSIONS: These data show that insertion of SEMS as a bridge to surgery in the management of left-sided colon cancer obstruction is possibly associated with adverse oncologic outcomes compared with nonobstructing elective surgery, but it is unclear what magnitude of this effect is related to the underlying obstruction rather than to the SEMS.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Nam Kyu(김남규) ORCID logo https://orcid.org/0000-0003-0639-5632
Kim, Jin Soo(김진수)
Min, Byung Soh(민병소) ORCID logo https://orcid.org/0000-0003-0180-8565
Sohn, Seung Kook(손승국)
Cho, Chang Hwan(조장환)
Hur, Hyuk(허혁) ORCID logo https://orcid.org/0000-0002-9864-7229
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