Does the diameter of colonic stent influence the outcomes in bridge-to-surgery patients with malignant large bowel obstr
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ORIGINAL ARTICLE
Does the diameter of colonic stent influence the outcomes in bridge‑to‑surgery patients with malignant large bowel obstruction? Akihisa Matsuda1 · Takeshi Yamada1 · Goro Takahashi1 · Tetsutaka Toyoda2 · Satoshi Matsumoto3 · Seiichi Shinji1 · Ryo Ohta1 · Hiromichi Sonoda1 · Yasuyuki Yokoyama2 · Kumiko Sekiguchi1 · Hiroshi Yoshida1 Received: 26 June 2020 / Accepted: 13 October 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Purpose This study investigated the short- and long-term outcomes of 18- and 22-mm-diameter self-expandable metallic stent (SEMS) as a bridge to surgery (BTS) in patients with malignant large bowel obstruction (MLBO). Methods Sixty-nine pathological stage II and III colorectal cancer patients who underwent BTS were included in this multiinstitutional retrospective study. Patients were divided into two groups regarding the diameter of SEMS: an 18-mm group (n = 30) and a 22-mm group (n = 39). Results There was no significant difference in the clinical success rate, but both of the two re-obstructions observed occurred in the 18-mm group. The 18-mm group showed a trend toward a higher incidence of overall postoperative complications (Clavien-Dindo grading ≥ II) than the 22-mm group (33.3% vs. 10.3%, P = 0.061). The 3-year disease-free and overall survival showed no significant differences between the 18- and 22-mm groups (78.2% vs. 68.8%, P = 0.753 and 92.8% vs. 82.1%, P = 0.471, respectively). Conclusion SEMS of 18 and 22 mm diameter confer statistically equivalent short- and long-term outcomes as a BTS. Keywords Bridge to surgery · Malignant large bowel obstruction · Self-expandable metallic stent · Stent diameter
Introduction Colorectal cancer (CRC), which killed approximately 880,000 people worldwide in 2018, is the leading cause of cancer death [1]. Around 10% of patients with CRC develop malignant large bowel obstruction (MLBO) [2, 3]. MLBO Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00595-020-02185-2) contains supplementary material, which is available to authorized users. * Akihisa Matsuda a‑[email protected] 1
Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1‑1‑5 Sendagi, Bunkyo‑ku, Tokyo 113‑8603, Japan
2
Department of Gastrointestinal Hepato‑Biliary‑Pancreatic Surgery, Nippon Medical School Musashi Kosugi Hospital, 1‑396 Kosugi‑cho, Nakahara‑ku, Kawasaki, Kanagawa 211‑8533, Japan
3
Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamagari, Inzai, Chiba 270‑1694, Japan
can develop into a so-called “oncologic emergency”, which may lead to a critically ill condition or even death. The traditional treatment choice for MLBO is emergency surgery, which is reported to carry high morbidity and mortality rates due to patients’ poor general and intestinal conditions [2–5]. In addition, emergency surgery for MLBO frequently requires stoma creation, which deteriorates patients’ quality of life (QOL) and is not always reversed, even when
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