Bridge-to-surgery versus emergency surgery in the management of left-sided acute malignant colorectal obstruction - Efficacy, safety and long-term outcomes

• Type: Article in International Scientific Journal
• Date: 2019

Authors

Rodrigues Pinto, E (Author) Other; Morais, R (Author) Other; Coelho, C (Author) Other; Pereira, P (Author) Other; Repici, A (Author) Other; Macedo G (Author) FMUP

Journal

Title: Digestive and Liver Disease

Vol. 51

Pages: 364-372

ISSN: 1590-8658

Publisher: Elsevier

Indexing

ISI Web of Knowledge - 28 Citations

Scopus - 28 Citations

Other information

Authenticus ID: P-00Q-0ZD

DOI: 10.1016/j.dld.2018.11.006

Abstract (EN): Objective: Compare efficacy, safety and long-term outcomes of bridge-to-surgery and emergency surgery in acute malignant colorectal obstruction. Methods: Retrospective study of 94 consecutive patients with left-sided acute malignant colorectal obstruction treated with curative intent between 2010-2017. Results: 48 patients underwent stent placement and 46 underwent emergency surgery. Technical and clinical success were 100% and 87%. Laparoscopy and one-staged operation were more frequent in bridge-to-surgery (44% vs 2%, p < 0.001; 73% vs 30%, p < 0.001). Fewer permanent stomas were created in bridge-to-surgery (15% vs 35%, p = 0.013). Overall morbidity was 36%. Immediate and post-procedure stent related-complications occurred in 6% and 13%; surgery-related complications occurred in 28% (bridge-to-surgery: 15% vs emergency surgery: 41%, p = 0.004). No differences were found regarding tumor recurrence, recurrence-free survival and overall survival. R1 resection (HR 47.2, 95%CI:4.1-543.7), number of lymph nodes harvested (HR 0.9 95%CI:0.8-0.99) and adjuvant therapy (HR 0.1 95%CI:0.01-0.9) predicted recurrence-free survival; pTMN stage IV (HR 7.3, 95%CI:1.1-47.6), number of lymph nodes harvested (HR 0.90, 95%CI:0.8-0.97), adjuvant therapy (HR 0.1, 95%CI:0.02-0.4) and surgery-related complications (HR 5.3, 95%CI:102-27.3) influenced overall survival. Conclusion: Stent placement has a high success, similarly to emergency surgery, being associated with higher primary anastomosis and lower stoma rates. Tumor recurrence rate, recurrence-free survival and overall survival were comparable between groups; surgery-related complications influenced overall survival.

Language: English

Type (Professor's evaluation): Dissemination

No. of pages: 9