PMID- 33743658
OWN - NLM
STAT- MEDLINE
DCOM- 20210331
LR  - 20210331
IS  - 1471-2482 (Electronic)
IS  - 1471-2482 (Linking)
VI  - 21
IP  - 1
DP  - 2021 Mar 20
TI  - Propensity score-matched comparison of stenting as a bridge to surgery and 
      emergency surgery for acute malignant left-sided colonic obstruction.
PG  - 148
LID - 10.1186/s12893-021-01144-z [doi]
LID - 148
AB  - BACKGROUND: Bridge to elective surgery (BTS) using self-expanding metal stents 
      (SEMSs) is a common alternative to emergency surgery (ES) for acute malignant 
      left-sided colonic obstruction (AMLCO). However, studies regarding the long-term 
      impact of BTS are limited and have reported unclear results. METHODS: A 
      multicenter observational study was performed at three hospitals from April 2012 
      to December 2019. Propensity score matching (PSM) was introduced to minimize 
      selection bias. The primary endpoint was overall survival. The secondary 
      endpoints included surgical approaches, primary resection types, total 
      stent-related adverse effects (AEs), surgical AEs, length of hospital stay, 
      30-day mortality and tumor recurrence. RESULTS: Forty-nine patients in both the 
      BTS and ES groups were matched. Patients in the BTS group more often underwent 
      laparoscopic resection [31 (63.3%) vs. 8 (16.3%), p < 0.001], were less likely to 
      have a primary stoma [13 (26.5%) vs. 26 (53.1%), p = 0.007] and more often had 
      perineural invasion [25 (51.0 %) vs. 13 (26.5 %), p = 0.013]. The median overall 
      survival was significantly lower in patients with stent insertion (41 vs. 
      65 months, p = 0.041). The 3-year overall survival (53.0 vs. 77.2%, p = 0.039) 
      and 5-year overall survival (30.6 vs. 55.0%, p = 0.025) were significantly less 
      favorable in the BTS group. In multivariate Cox regression analysis, stenting 
      (hazard ratio(HR) = 2.309(1.052-5.066), p = 0.037), surgical AEs (HR = 1.394 
      (1.053-1.845), p = 0.020) and pTNM stage (HR = 1.706 (1.116-2.607), p = 0.014) 
      were positively correlated with overall survival in matched patients. 
      CONCLUSIONS: Self-expanding metal stents as "a bridge to surgery" are associated 
      with more perineural invasion, a higher recurrence rate and worse overall 
      survival in patients with acute malignant left-sided colonic obstruction compared 
      with emergency surgery.
FAU - Cao, Yuepeng
AU  - Cao Y
AD  - Department of General Surgery, Tongji Hospital, Tongji University School of 
      Medicine, 389 Xincun Road, 200065, Shanghai, China.
AD  - Department of Colorectal Surgery, Ningbo First Hospital, 315010, Ningbo, China.
FAU - Chen, Qing
AU  - Chen Q
AD  - Department of General Surgery, Shanghai Tenth People's Hospital, Tongji 
      University School of Medicine, 200072, Shanghai, China.
FAU - Ni, Zhizhan
AU  - Ni Z
AD  - Department of General Surgery, Tongji Hospital, Tongji University School of 
      Medicine, 389 Xincun Road, 200065, Shanghai, China.
FAU - Wu, Feng
AU  - Wu F
AD  - Department of General Surgery, Tongji Hospital, Tongji University School of 
      Medicine, 389 Xincun Road, 200065, Shanghai, China.
AD  - Department of General Surgery, Hwa Mei Hospital, University of Chinese Academy of 
      Sciences, 315010, Ningbo, China.
FAU - Huang, Chenshen
AU  - Huang C
AD  - Department of General Surgery, Tongji Hospital, Tongji University School of 
      Medicine, 389 Xincun Road, 200065, Shanghai, China.
FAU - Zhou, Jinzhe
AU  - Zhou J
AD  - Department of General Surgery, Tongji Hospital, Tongji University School of 
      Medicine, 389 Xincun Road, 200065, Shanghai, China.
FAU - Zhang, Songze
AU  - Zhang S
AD  - Department of General Surgery, Tongji Hospital, Tongji University School of 
      Medicine, 389 Xincun Road, 200065, Shanghai, China.
FAU - Ge, Bujun
AU  - Ge B
AD  - Department of General Surgery, Tongji Hospital, Tongji University School of 
      Medicine, 389 Xincun Road, 200065, Shanghai, China. bujun_ge@163.com.
FAU - Huang, Qi
AU  - Huang Q
AD  - Department of General Surgery, Tongji Hospital, Tongji University School of 
      Medicine, 389 Xincun Road, 200065, Shanghai, China. hqhq007@hotmail.com.
LA  - eng
GR  - JK2017-3/Karamay Municipal Science and Technology Foundation/
GR  - ITJ(ZD)1804/The Research and Development Fund Project of Tongji Hospital/
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Observational Study
DEP - 20210320
PL  - England
TA  - BMC Surg
JT  - BMC surgery
JID - 100968567
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - *Colonic Diseases/surgery/therapy
MH  - *Emergency Treatment
MH  - Female
MH  - Humans
MH  - *Intestinal Obstruction/surgery/therapy
MH  - Male
MH  - Middle Aged
MH  - Propensity Score
MH  - *Stents
MH  - Treatment Outcome
PMC - PMC7981848
OTO - NOTNLM
OT  - Acute malignant left-sided colonic obstruction
OT  - Overall survival
OT  - Propensity score matching
OT  - Self-expanding metallic stent
COIS- The authors declare that they have no competing interests.
EDAT- 2021/03/22 06:00
MHDA- 2021/04/01 06:00
PMCR- 2021/03/20
CRDT- 2021/03/21 20:28
PHST- 2020/11/03 00:00 [received]
PHST- 2021/03/10 00:00 [accepted]
PHST- 2021/03/21 20:28 [entrez]
PHST- 2021/03/22 06:00 [pubmed]
PHST- 2021/04/01 06:00 [medline]
PHST- 2021/03/20 00:00 [pmc-release]
AID - 10.1186/s12893-021-01144-z [pii]
AID - 1144 [pii]
AID - 10.1186/s12893-021-01144-z [doi]
PST - epublish
SO  - BMC Surg. 2021 Mar 20;21(1):148. doi: 10.1186/s12893-021-01144-z.