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Long-term outcomes after stenting as a bridge to surgery in patients with obstructing left-sided colorectal cancer

Authors
 Jihye Park  ;  Hyun Jung Lee  ;  Soo Jung Park  ;  Hyuk Hur  ;  Byung Soh Min  ;  Jae Hee Cheon  ;  Tae Il Kim  ;  Nam Kyu Kim  ;  Won Ho Kim 
Citation
 International Journal of Colorectal Disease, Vol.33(6) : 799-807, 2018 
Journal Title
 International Journal of Colorectal Disease 
ISSN
 0179-1958 
Issue Date
2018
MeSH
Aged ; Colorectal Neoplasms/surgery* ; Demography ; Disease-Free Survival ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neoplasm Recurrence, Local/pathology ; Perioperative Care ; Proportional Hazards Models ; Stents* ; Time Factors ; Treatment Outcome
Keywords
Bridge to surgery ; Colorectal neoplasms ; Outcome ; SEMS
Abstract
PURPOSE: Self-expandable metallic stents (SEMS) may be used in acute, obstructing, left-sided colorectal cancer (CRC) to avoid high-risk emergency surgery. However, the data regarding the long-term effects of SEMS as a bridge to surgery are limited and contradictory. Our aim is to analyze the long-term oncological outcomes of SEMS compared with surgery. METHODS: Between January 2006 and November 2013, a total of 855 patients with stage III CRC were regularly followed at the CRC clinic of Severance Hospital, Seoul, Korea. We retrospectively evaluated their 5-year disease-free survival (DFS), 5-year overall survival (OS), and 5-year cancer-specific survival (CSS). RESULTS: There were 94 patients in the SEMS group, 17 in the emergent-surgery group, and 744 in the elective-surgery group. In the short term, the rate of permanent stoma formation was significantly higher in the emergent-surgery group than in the SEMS group (p = 0.030), although the median hospital stay and overall complication rate were comparable. During the long-term follow-up period, oncological outcomes including 5-year DFS (70.2 vs 52.9%; p = 0.210), OS (70.2 vs 52.9%; p = 0.148), and CSS (79.8 vs 70.6%; p = 0.342) were not different between the SEMS group and the emergent-surgery group. Multivariate analysis showed emergent operation to be a significant risk factor of DFS (hazard ratio [HR], 3.117; 95% confidence interval [CI], 1.498-6.489; p = 0.002). CONCLUSIONS: Preoperative SEMS insertion does not adversely affect long-term oncological outcomes or patient survival.
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/165093
Full Text
https://link.springer.com/article/10.1007%2Fs00384-018-3009-7
DOI
10.1007/s00384-018-3009-7
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
Yonsei Authors
김남규(Kim, Nam Kyu) ORCID logo https://orcid.org/0000-0003-0639-5632
김원호(Kim, Won Ho)
김태일(Kim, Tae Il) ORCID logo https://orcid.org/0000-0003-4807-890X
민병소(Min, Byung Soh)
박수정(Park, Soo Jung)
박지혜(Park, Ji Hye)
이현정(Lee, Hyun Jung)
천재희(Cheon, Jae Hee) ORCID logo https://orcid.org/0000-0002-2282-8904
허혁(Hur, Hyuk) ORCID logo https://orcid.org/0000-0002-9864-7229
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