Propensity score‐matched comparison of stenting as a bridge to surgery and emergency surgery for acute malignant left‐sided colonic obstruction
Abstract 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 re...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-03-01
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| Series: | BMC Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12893-021-01144-z |
| _version_ | 1818576506542096384 |
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| author | Yuepeng Cao Qing Chen Zhizhan Ni Feng Wu Chenshen Huang Jinzhe Zhou Songze Zhang Bujun Ge Qi Huang |
| author_facet | Yuepeng Cao Qing Chen Zhizhan Ni Feng Wu Chenshen Huang Jinzhe Zhou Songze Zhang Bujun Ge Qi Huang |
| author_sort | Yuepeng Cao |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-12-16T06:15:06Z |
| format | Article |
| id | doaj.art-b8062b4351c8443489b045a93e49cf6d |
| institution | Directory Open Access Journal |
| issn | 1471-2482 |
| language | English |
| last_indexed | 2024-12-16T06:15:06Z |
| publishDate | 2021-03-01 |
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| record_format | Article |
| series | BMC Surgery |
| spelling | doaj.art-b8062b4351c8443489b045a93e49cf6d2022-12-21T22:41:17ZengBMCBMC Surgery1471-24822021-03-012111910.1186/s12893-021-01144-zPropensity score‐matched comparison of stenting as a bridge to surgery and emergency surgery for acute malignant left‐sided colonic obstructionYuepeng Cao0Qing Chen1Zhizhan Ni2Feng Wu3Chenshen Huang4Jinzhe Zhou5Songze Zhang6Bujun Ge7Qi Huang8Department of General Surgery, Tongji Hospital, Tongji University School of MedicineDepartment of General Surgery, Shanghai Tenth People’s Hospital, Tongji University School of MedicineDepartment of General Surgery, Tongji Hospital, Tongji University School of MedicineDepartment of General Surgery, Tongji Hospital, Tongji University School of MedicineDepartment of General Surgery, Tongji Hospital, Tongji University School of MedicineDepartment of General Surgery, Tongji Hospital, Tongji University School of MedicineDepartment of General Surgery, Tongji Hospital, Tongji University School of MedicineDepartment of General Surgery, Tongji Hospital, Tongji University School of MedicineDepartment of General Surgery, Tongji Hospital, Tongji University School of MedicineAbstract 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.https://doi.org/10.1186/s12893-021-01144-zAcute malignant left‐sided colonic obstructionSelf‐expanding metallic stentPropensity score matchingOverall survival |
| spellingShingle | Yuepeng Cao Qing Chen Zhizhan Ni Feng Wu Chenshen Huang Jinzhe Zhou Songze Zhang Bujun Ge Qi Huang Propensity score‐matched comparison of stenting as a bridge to surgery and emergency surgery for acute malignant left‐sided colonic obstruction BMC Surgery Acute malignant left‐sided colonic obstruction Self‐expanding metallic stent Propensity score matching Overall survival |
| title | Propensity score‐matched comparison of stenting as a bridge to surgery and emergency surgery for acute malignant left‐sided colonic obstruction |
| title_full | Propensity score‐matched comparison of stenting as a bridge to surgery and emergency surgery for acute malignant left‐sided colonic obstruction |
| title_fullStr | Propensity score‐matched comparison of stenting as a bridge to surgery and emergency surgery for acute malignant left‐sided colonic obstruction |
| title_full_unstemmed | Propensity score‐matched comparison of stenting as a bridge to surgery and emergency surgery for acute malignant left‐sided colonic obstruction |
| title_short | Propensity score‐matched comparison of stenting as a bridge to surgery and emergency surgery for acute malignant left‐sided colonic obstruction |
| title_sort | propensity score matched comparison of stenting as a bridge to surgery and emergency surgery for acute malignant left sided colonic obstruction |
| topic | Acute malignant left‐sided colonic obstruction Self‐expanding metallic stent Propensity score matching Overall survival |
| url | https://doi.org/10.1186/s12893-021-01144-z |
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