Publicação
Oncological outcomes of colonic stents as “bridge to surgery” versus emergency surgery for obstructive colorectal cancer: A portuguese comparative study
| Resumo: | Introduction: The short-term results of colonic stenting followed by elective surgery (bridge to surgery, BTS) for malignant large- -bowel obstruction (MLBO) have been well described. However long-term oncological outcomes are still debated and interna- tional endoscopy societies have recently not recommended it as a first-line approach. Aims & Methods: A longitudinal observational cohort study was performed based on clinical data review from patients treated in our center between 2006 and 2012 (7 years). We analysed disease-free survival (DFS), overall survival (OS) and recurrence as primary end-points. We also reviewed demographic data, disease staging and peri-operatory morbility and mortality. Results: A total of 126 patients were included: 79 (62,7%) were treated with a BTS strategy (group 1) and 47 (37,3%) underwent an emergent surgery (group 2). The distribution by sex, age (70,9+/-11,4 years) and TNM stage was similiar. The median follow-up time was 49,2 +/- 3,6 months. There was no significant difference in peri-operatory complications (p=0,23) and adjuvant chemotherapy (p=0,53). The need for a definite stoma was higher in group 2 (p<0,001). The recurrence did not differ significantly between the two groups, although it was superior in group 2 (34,5% vs. 42,5%,p=0,492). DFS (22,2 vs 19,7 months; p=0,652) and OS (43,2 vs. 31,9 months, p=0,096) also did not differ signficantly between the two groups, being slightly longer in group 1. Conclusion: Results of our study on oncological outcomes, as stated in most recent meta-analysis, as well as well-described short-term outcomes, suggest that BTS could be a promising alternative strategy for MLBO. Larger prospective studies and randomized clinical trials are definetely needed in the future. |
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| Autores principais: | Lourenço, L |
| Outros Autores: | Sousa, M; Oliveira, AM; Gomes, A; Rodrigues, C; Santos, I; Horta, D; Pignatelli, N; Nunes, V; Reis, J |
| Assunto: | Colorectal neoplasms Stents Neoplasias colorrectais Intestinal obstruction Obstrução intestinal |
| Ano: | 2016 |
| País: | Portugal |
| Tipo de documento: | artigo |
| Tipo de acesso: | acesso aberto |
| Instituição associada: | Hospital Prof. Dr. Fernando Fonseca E.P.E. |
| Idioma: | inglês |
| Origem: | Repositório do Hospital Prof. Doutor Fernando Fonseca |
| Resumo: | Introduction: The short-term results of colonic stenting followed by elective surgery (bridge to surgery, BTS) for malignant large- -bowel obstruction (MLBO) have been well described. However long-term oncological outcomes are still debated and interna- tional endoscopy societies have recently not recommended it as a first-line approach. Aims & Methods: A longitudinal observational cohort study was performed based on clinical data review from patients treated in our center between 2006 and 2012 (7 years). We analysed disease-free survival (DFS), overall survival (OS) and recurrence as primary end-points. We also reviewed demographic data, disease staging and peri-operatory morbility and mortality. Results: A total of 126 patients were included: 79 (62,7%) were treated with a BTS strategy (group 1) and 47 (37,3%) underwent an emergent surgery (group 2). The distribution by sex, age (70,9+/-11,4 years) and TNM stage was similiar. The median follow-up time was 49,2 +/- 3,6 months. There was no significant difference in peri-operatory complications (p=0,23) and adjuvant chemotherapy (p=0,53). The need for a definite stoma was higher in group 2 (p<0,001). The recurrence did not differ significantly between the two groups, although it was superior in group 2 (34,5% vs. 42,5%,p=0,492). DFS (22,2 vs 19,7 months; p=0,652) and OS (43,2 vs. 31,9 months, p=0,096) also did not differ signficantly between the two groups, being slightly longer in group 1. Conclusion: Results of our study on oncological outcomes, as stated in most recent meta-analysis, as well as well-described short-term outcomes, suggest that BTS could be a promising alternative strategy for MLBO. Larger prospective studies and randomized clinical trials are definetely needed in the future. |
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