Oncologic Outcomes of Self-Expandable Metallic Stent as a Bridge to Surgery and Safety and Feasibility of Minimally Invasive Surgery for Acute Malignant Colonic Obstruction

Seung Yoon Yang; Youn Young Park; Yoon Dae Han; Min Soo Cho; Hyuk Hur; Byung Soh Min; Kang Young Lee; Nam Kyu Kim

doi:10.1245/s10434-019-07346-3

Oncologic Outcomes of Self-Expandable Metallic Stent as a Bridge to Surgery and Safety and Feasibility of Minimally Invasive Surgery for Acute Malignant Colonic Obstruction

Seung Yoon Yang, Youn Young Park, Yoon Dae Han, Min Soo Cho, Hyuk Hur, Byung Soh Min, Kang Young Lee, Nam Kyu Kim

Department of Surgery

Research output: Contribution to journal › Article › peer-review

26 Citations (Scopus)

Abstract

Background: Although self-expandable metal stents (SEMS) are widely used as a bridge to surgery (BTS) in patients with malignant colorectal cancer obstruction, there has been some debate about their effect on long-term oncological outcomes. Furthermore, data on the safety and feasibility of minimally invasive surgery (MIS) combined with stent placement are scarce. We aimed to determine the long-term oncological outcomes of SEMS as a BTS, and the short-term outcomes of SEMS used with minimally invasive colorectal surgery. Methods: Data from patients who were admitted with malignant obstructing colon cancer between January 2006 and December 2015 were retrospectively reviewed; 71 patients underwent direct surgery and 182 patients underwent SEMS placement as a BTS. Long-term and short-term outcomes of the groups were compared. In a subgroup analysis of the BTS group, the short-term outcomes of conventional open surgery and MIS were compared. Results: There were no differences in long-term oncologic outcomes between groups. The primary anastomosis rate was higher in the stent group than in the direct surgery group. In the stent group, postoperative complication rates were lower in the minimally invasive group than in the open surgery group. Time to flatus and time to soft diet resumption were shorter in the minimally invasive group, as was length of hospital stay. Conclusions: Elective surgery after stent insertion does not adversely affect long-term oncologic outcomes. Furthermore, MIS combined with stent insertion for malignant colonic obstruction is safe and feasible.

Original language	English
Pages (from-to)	2787-2796
Number of pages	10
Journal	Annals of surgical oncology
Volume	26
Issue number	9
DOIs	https://doi.org/10.1245/s10434-019-07346-3
Publication status	Published - 2019 Sep 15

Bibliographical note

Funding Information:
SYY: Data collection and analysis, manuscript writing. YYP: Data collection, critical review. YDH: Data collection, critical review. MSC: Data collection, critical review. HH: Data collection, critical review. BSM: Data collection, critical review. KYL: Data collection, critical review. NKK: Study idea, design, data collection and analysis, manuscript writing The authors would like to thank Dong-Su Jang, MFA (Medical Illustrator) for his help with the illustrations. All procedures were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. This retrospective study was approved by the Institutional Review Board (IRB) of Severance Hospital, Yonsei University College of Medicine (4-2018-0191). Owing to the retrospective nature of the study, signed patient informed consent was waived as per the IRB approval. Seung Yoon Yang, Youn Young Park, Yoon Dae Han, Min Soo Cho, Hyuk Hur, Byung Soh Min, Kang Young Lee, and Nam Kyu Kim have no disclosures to declare. All authors have completed the disclosure declaration, and none of the authors or their immediate family members report any conflicting financial interest.

Publisher Copyright:
© 2019, Society of Surgical Oncology.

All Science Journal Classification (ASJC) codes

Surgery
Oncology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1245/s10434-019-07346-3

Cite this

@article{53d20402ca11449abe7aeaa3afeebda3,

title = "Oncologic Outcomes of Self-Expandable Metallic Stent as a Bridge to Surgery and Safety and Feasibility of Minimally Invasive Surgery for Acute Malignant Colonic Obstruction",

abstract = "Background: Although self-expandable metal stents (SEMS) are widely used as a bridge to surgery (BTS) in patients with malignant colorectal cancer obstruction, there has been some debate about their effect on long-term oncological outcomes. Furthermore, data on the safety and feasibility of minimally invasive surgery (MIS) combined with stent placement are scarce. We aimed to determine the long-term oncological outcomes of SEMS as a BTS, and the short-term outcomes of SEMS used with minimally invasive colorectal surgery. Methods: Data from patients who were admitted with malignant obstructing colon cancer between January 2006 and December 2015 were retrospectively reviewed; 71 patients underwent direct surgery and 182 patients underwent SEMS placement as a BTS. Long-term and short-term outcomes of the groups were compared. In a subgroup analysis of the BTS group, the short-term outcomes of conventional open surgery and MIS were compared. Results: There were no differences in long-term oncologic outcomes between groups. The primary anastomosis rate was higher in the stent group than in the direct surgery group. In the stent group, postoperative complication rates were lower in the minimally invasive group than in the open surgery group. Time to flatus and time to soft diet resumption were shorter in the minimally invasive group, as was length of hospital stay. Conclusions: Elective surgery after stent insertion does not adversely affect long-term oncologic outcomes. Furthermore, MIS combined with stent insertion for malignant colonic obstruction is safe and feasible.",

author = "Yang, {Seung Yoon} and Park, {Youn Young} and Han, {Yoon Dae} and Cho, {Min Soo} and Hyuk Hur and Min, {Byung Soh} and Lee, {Kang Young} and Kim, {Nam Kyu}",

note = "Funding Information: SYY: Data collection and analysis, manuscript writing. YYP: Data collection, critical review. YDH: Data collection, critical review. MSC: Data collection, critical review. HH: Data collection, critical review. BSM: Data collection, critical review. KYL: Data collection, critical review. NKK: Study idea, design, data collection and analysis, manuscript writing The authors would like to thank Dong-Su Jang, MFA (Medical Illustrator) for his help with the illustrations. All procedures were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. This retrospective study was approved by the Institutional Review Board (IRB) of Severance Hospital, Yonsei University College of Medicine (4-2018-0191). Owing to the retrospective nature of the study, signed patient informed consent was waived as per the IRB approval. Seung Yoon Yang, Youn Young Park, Yoon Dae Han, Min Soo Cho, Hyuk Hur, Byung Soh Min, Kang Young Lee, and Nam Kyu Kim have no disclosures to declare. All authors have completed the disclosure declaration, and none of the authors or their immediate family members report any conflicting financial interest. Publisher Copyright: {\textcopyright} 2019, Society of Surgical Oncology.",

year = "2019",

month = sep,

day = "15",

doi = "10.1245/s10434-019-07346-3",

language = "English",

volume = "26",

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Oncologic Outcomes of Self-Expandable Metallic Stent as a Bridge to Surgery and Safety and Feasibility of Minimally Invasive Surgery for Acute Malignant Colonic Obstruction. / Yang, Seung Yoon; Park, Youn Young; Han, Yoon Dae et al.

In: Annals of surgical oncology, Vol. 26, No. 9, 15.09.2019, p. 2787-2796.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Oncologic Outcomes of Self-Expandable Metallic Stent as a Bridge to Surgery and Safety and Feasibility of Minimally Invasive Surgery for Acute Malignant Colonic Obstruction

AU - Yang, Seung Yoon

AU - Park, Youn Young

AU - Han, Yoon Dae

AU - Cho, Min Soo

AU - Hur, Hyuk

AU - Min, Byung Soh

AU - Lee, Kang Young

AU - Kim, Nam Kyu

N1 - Funding Information: SYY: Data collection and analysis, manuscript writing. YYP: Data collection, critical review. YDH: Data collection, critical review. MSC: Data collection, critical review. HH: Data collection, critical review. BSM: Data collection, critical review. KYL: Data collection, critical review. NKK: Study idea, design, data collection and analysis, manuscript writing The authors would like to thank Dong-Su Jang, MFA (Medical Illustrator) for his help with the illustrations. All procedures were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. This retrospective study was approved by the Institutional Review Board (IRB) of Severance Hospital, Yonsei University College of Medicine (4-2018-0191). Owing to the retrospective nature of the study, signed patient informed consent was waived as per the IRB approval. Seung Yoon Yang, Youn Young Park, Yoon Dae Han, Min Soo Cho, Hyuk Hur, Byung Soh Min, Kang Young Lee, and Nam Kyu Kim have no disclosures to declare. All authors have completed the disclosure declaration, and none of the authors or their immediate family members report any conflicting financial interest. Publisher Copyright: © 2019, Society of Surgical Oncology.

PY - 2019/9/15

Y1 - 2019/9/15

N2 - Background: Although self-expandable metal stents (SEMS) are widely used as a bridge to surgery (BTS) in patients with malignant colorectal cancer obstruction, there has been some debate about their effect on long-term oncological outcomes. Furthermore, data on the safety and feasibility of minimally invasive surgery (MIS) combined with stent placement are scarce. We aimed to determine the long-term oncological outcomes of SEMS as a BTS, and the short-term outcomes of SEMS used with minimally invasive colorectal surgery. Methods: Data from patients who were admitted with malignant obstructing colon cancer between January 2006 and December 2015 were retrospectively reviewed; 71 patients underwent direct surgery and 182 patients underwent SEMS placement as a BTS. Long-term and short-term outcomes of the groups were compared. In a subgroup analysis of the BTS group, the short-term outcomes of conventional open surgery and MIS were compared. Results: There were no differences in long-term oncologic outcomes between groups. The primary anastomosis rate was higher in the stent group than in the direct surgery group. In the stent group, postoperative complication rates were lower in the minimally invasive group than in the open surgery group. Time to flatus and time to soft diet resumption were shorter in the minimally invasive group, as was length of hospital stay. Conclusions: Elective surgery after stent insertion does not adversely affect long-term oncologic outcomes. Furthermore, MIS combined with stent insertion for malignant colonic obstruction is safe and feasible.

AB - Background: Although self-expandable metal stents (SEMS) are widely used as a bridge to surgery (BTS) in patients with malignant colorectal cancer obstruction, there has been some debate about their effect on long-term oncological outcomes. Furthermore, data on the safety and feasibility of minimally invasive surgery (MIS) combined with stent placement are scarce. We aimed to determine the long-term oncological outcomes of SEMS as a BTS, and the short-term outcomes of SEMS used with minimally invasive colorectal surgery. Methods: Data from patients who were admitted with malignant obstructing colon cancer between January 2006 and December 2015 were retrospectively reviewed; 71 patients underwent direct surgery and 182 patients underwent SEMS placement as a BTS. Long-term and short-term outcomes of the groups were compared. In a subgroup analysis of the BTS group, the short-term outcomes of conventional open surgery and MIS were compared. Results: There were no differences in long-term oncologic outcomes between groups. The primary anastomosis rate was higher in the stent group than in the direct surgery group. In the stent group, postoperative complication rates were lower in the minimally invasive group than in the open surgery group. Time to flatus and time to soft diet resumption were shorter in the minimally invasive group, as was length of hospital stay. Conclusions: Elective surgery after stent insertion does not adversely affect long-term oncologic outcomes. Furthermore, MIS combined with stent insertion for malignant colonic obstruction is safe and feasible.

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Oncologic Outcomes of Self-Expandable Metallic Stent as a Bridge to Surgery and Safety and Feasibility of Minimally Invasive Surgery for Acute Malignant Colonic Obstruction

Abstract

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