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Annals of Surgery:
doi: 10.1097/SLA.0b013e31827e30ce
Original Articles

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*

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Abstract

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.

© 2013 by Lippincott Williams & Wilkins.

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