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Colonic perforation either during or after stent insertion as a bridge to surgery for malignant colorectal obstruction increases the risk of peritoneal seeding

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Abstract

Background

Endoscopic colorectal stenting may be performed as a bridge to surgery in patients with malignant colorectal obstruction, and has been reported to be associated with a high rate of successful primary anastomosis, low rate of stoma formation, and shorter hospital stay. However, the results of recent studies suggest that colorectal stenting could potentially worsen the prognosis. This study aimed to compare outcomes between patients who underwent colorectal stenting as a bridge to surgery and patients who underwent curative surgery only for malignant colorectal obstruction.

Methods

This study included patients with malignant colorectal obstruction and symptomatic bowel dilatation who were treated by stenting as a bridge to surgery (stent group, n = 27) or surgical resection only (surgery-only group, n = 29) between May 2009 and May 2012. The short-term outcomes evaluated were the primary anastomosis rate, length of hospital stay, and rates of emergency and open surgery. The long-term outcomes evaluated were overall survival (OS) and recurrence-free survival (RFS).

Results

The primary outcomes were similar in the two groups. There were no significant differences between the stent and surgery-only groups in 3-year OS (85.2 vs. 82.8 %; p = 0.655) or 3-year RFS (80.7 vs. 78.6 %; p = 0.916). The odds ratio for seeded metastasis after perforation either during or after stent placement was 46.0 (95 % CI, 2.0–1,047.8; p = 0.016).

Conclusions

Colorectal stenting as a bridge to surgery showed no significant short- or long-term benefits compared with surgery only, and was associated with peritoneal seeding after perforation. Stenting before surgery should therefore only be considered in patients with a high risk of complications associated with emergency surgery.

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Disclosure

Su Jin Kim, Hyung Wook Kim, Su Bum Park, Dae Hwan Kang, Cheol Woong Choi, Byeong Jun Song, Joung Boom Hong, Dong Jun Kim, Byung Soo Park, and Gyung Mo Son have no conflicts of interest or financial relationships to disclose.

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Authors and Affiliations

  1. Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Beomeo-ri, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Yangsan, 626-770, Korea

    Su Jin Kim, Hyung Wook Kim, Su Bum Park, Dae Hwan Kang, Cheol Woong Choi, Byeong Jun Song, Joung Boom Hong & Dong Jun Kim

  2. Department of Surgery, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea

    Byung Soo Park & Gyung Mo Son

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  1. Su Jin Kim
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Correspondence to Su Jin Kim.

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Kim, S.J., Kim, H.W., Park, S.B. et al. Colonic perforation either during or after stent insertion as a bridge to surgery for malignant colorectal obstruction increases the risk of peritoneal seeding. Surg Endosc 29, 3499–3506 (2015). https://doi.org/10.1007/s00464-015-4100-6

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  • DOI: https://doi.org/10.1007/s00464-015-4100-6

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