Colonic Stents as a Bridge to Surgery Compared with Immediate Resection in Patients with Malignant Large Bowel Obstructi
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ORIGINAL ARTICLE
Colonic Stents as a Bridge to Surgery Compared with Immediate Resection in Patients with Malignant Large Bowel Obstruction in a NY State Database Patrick T. Dolan 1 & Jonathan S. Abelson 1 & Matthew Symer 1 & Molly Nowels 2 & Art Sedrakyan 2 & Heather L. Yeo 1,2 Received: 10 November 2019 / Accepted: 6 September 2020 # 2020 The Society for Surgery of the Alimentary Tract
Abstract Background There is controversy surrounding the efficacy and safety of colonic stents as a bridge to surgery compared with immediate resection in patients presenting with an acute malignant large bowel obstruction. Methods Retrospective longitudinal cohort study using the NYS SPARCS Database. Patients with acute malignant large bowel obstruction who either had stent followed by elective surgery within 3 weeks (bridge to surgery) or underwent immediate resection between October 2009 and June 2016 in the state of New York were included. The primary outcome was rate of stoma creation at index resection. Secondary outcomes were 90-day readmission, reoperation, procedural complications, and discharge disposition. Results A total of 3059 patients were included, n = 2917 (95.4%) underwent an immediate resection and n = 142 (4.6%) underwent bridge to surgery. We analyzed 139 patients in propensity score-matched groups. Patients in the bridge to surgery group were less likely than those in the immediate resection group to get a stoma at the time of surgery (OR 0.33, 95% CI 0.18–0.60). They were also less likely to be discharged to a rehabilitation facility or require a home health aide upon discharge (OR 0.36, 95% CI 0.22–0.61). There were no differences in rates of 90-day readmission, reoperation, or procedural complications between groups. Discussion Colonic stenting as a bridge to surgery leads to less stoma creation, a significant quality of life advantage, compared with immediate resection. Patients should be counseled regarding these potential benefits when the technology is available. Keywords Malignant large bowel obstruction . Colon stents . Stent as a bridge to surgery
Introduction Colorectal cancer is the third most common cause of cancer in the USA, with approximately 145,000 new cases estimated 1 for 2019. It is estimated that 8–29% of patients with colorectal cancer initially present with an obstruction requiring emer2 gent intervention. , 3 Historically, the mainstay of treatment involved emergency surgery, resection with or without diversion or diversion alone, with high rates of morbidity (up to
* Heather L. Yeo [email protected] 1
Department of Surgery, Weill Medical College of Cornell University, New York-Presbyterian Hospital, 525 East 68th Street, Box 172, New York, NY 10065, USA
2
Department of Healthcare Policy and Research, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, NY, USA
46%) and mortality (up to 28%), as well as high rates of stoma 4 creation (up to 20%) in resected patients. –7 A newer option in potentially resectable patients is to alleviate the
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