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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

Sabbagh, Charles MD*,‖; Browet, François MD*; Diouf, Momar PhD; Cosse, Cyril MD*,‖; Brehant, Olivier MD*; Bartoli, Eric MD; Mauvais, François MD§; Chauffert, Bruno MD, PhD; Dupas, Jean-Louis MD; Nguyen-Khac, Eric MD, PhD; Regimbeau, Jean-Marc MD, PhD*

doi: 10.1097/SLA.0b013e31827e30ce
Original Articles

Objective and Background: Self-expanding metallic stent (SEMS) insertion has been suggested as a promising alternative to emergency surgery for left-sided malignant colonic obstruction (LMCO). However, the literature on the long-term impact of SEMS as “a bridge to surgery” is limited and contradictory.

Methods: From January 1998 to June 2011, we retrospectively identified patients operated on for LMCO with curative intent. The primary outcome criterion was overall survival. Short-term secondary endpoints included the technical success rate and overall success rate and long-term secondary endpoints included 5-year overall survival, 5-year cancer-specific mortality, 5-year disease-free survival, the recurrence rate, and mean time to recurrence. Patients treated with SEMS were analyzed on an intention-to-treat basis. Overall survival was analyzed after using a propensity score to correct for selection bias.

Results: There were 48 patients in the SEMS group and 39 in the surgery-only group. In the overall population, overall survival (P = 0.001) and 5-year overall survival (P = 0.0003) were significantly lower in the SEMS group than in the surgery-only group, and 5-year cancer-specific mortality was significantly higher in the SEMS group (48% vs 21%, respectively (P = 0.02)). Five-year disease-free survival, the recurrence rate, and the mean time to recurrence were better in the surgery-only group (not significant). For patients with no metastases or perforations at hospital admission, overall survival (P = 0.003) and 5-year overall survival (30% vs 67%, respectively, P = 0.001) were significantly lower in the SEMS group than in the surgery-only group.

Conclusions: Our study results suggest worse overall survival of patients with LMCO with SEMS insertion compared with immediate surgery.

Self-expanding metallic stent (SEMS) insertion has been suggested as a promising alternative to emergency surgery for malignant colonic obstruction (LMCO). Patients treated with SEMS were analyzed on an intention-to-treat basis. Overall survival was analyzed after using a propensity score to correct for selection bias. Our study results suggest worse overall survival of patients with LMCO with SEMS insertion compared with immediate surgery.

Departments of *Digestive and Metabolic Surgery

Innovation and Clinical Research

Hepatogastroenterology, North Hospital, Amiens University Medical Center, place Victor Pauchet, Amiens, France

§Department of Digestive, Visceral and Urologic Surgery, Beauvais Medical Center, Beauvais, France

Department of Medical Oncology, South Hospital, Amiens University Medical Center, Amiens, France

INSERM U 1088 (EA 4292), Jules Verne University of Picardy, Amiens, France.

Reprints: Jean-Marc Regimbeau, MD, PhD, Department of Digestive and Metabolic Surgery, North Hospital, Amiens University Medical Center, place Victor Pauchet, F-80054 Amiens cedex 01, France. E-mail: regimbeau.jean-marc@chu-amiens.fr.

Disclosure: The authors declare no conflicts of interest.

© 2013 by Lippincott Williams & Wilkins.