Propensity score-matched analysis of oncological outcome between stent as bridge to surgery and emergency resection in patients with malignant left-sided colonic obstruction

F. J. Amelung, W. A. A. Borstlap, E. C. J. Consten, J. V. Veld, E. E. van Halsema, W. A. Bemelman, P. D. Siersema, F. ter Borg, JE van Hooft, PJ Tanis, on behalf of the Dutch Snapshot Research Group

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Although self-expandable metal stent (SEMS) placement as bridge to surgery (BTS) in patients with left-sided obstructing colonic cancer has shown promising short-term results, it is used infrequently owing to uncertainty about its oncological safety. This population study compared long-term oncological outcomes between emergency resection and SEMS placement as BTS. Methods: Through a national collaborative research project, long-term outcome data were collected for all patients who underwent resection for left-sided obstructing colonic cancer between 2009 and 2016 in 75 Dutch hospitals. Patients were identified from the Dutch Colorectal Audit database. SEMS as BTS was compared with emergency resection in the curative setting after 1 : 2 propensity score matching. Results: Some 222 patients who had a stent placed were matched to 444 who underwent emergency resection. The overall SEMS-related perforation rate was 7·7 per cent (17 of 222). Three-year locoregional recurrence rates after SEMS insertion and emergency resection were 11·4 and 13·6 per cent (P = 0·457), disease-free survival rates were 58·8 and 52·6 per cent (P = 0·175), and overall survival rates were 74·0 and 68·3 per cent (P = 0·231), respectively. SEMS placement resulted in significantly fewer permanent stomas (23·9 versus 45·3 per cent; P < 0·001), especially in elderly patients (29·0 versus 57·9 per cent; P < 0·001). For patients in the SEMS group with or without perforation, 3-year locoregional recurrence rates were 18 and 11·0 per cent (P = 0·432), disease-free survival rates were 49 and 59·6 per cent (P = 0·717), and overall survival rates 61 and 75·1 per cent (P = 0·529), respectively. Conclusion: Overall, SEMS as BTS seems an oncologically safe alternative to emergency resection with fewer permanent stomas. Nevertheless, the risk of SEMS-related perforation, as well as permanent stoma, might influence shared decision-making for individual patients.

Original languageEnglish
Pages (from-to)1075-1086
Number of pages12
JournalBritish Journal of Surgery
Volume106
Issue number8
DOIs
Publication statusPublished - 1 Jul 2019

Cite this

Amelung, F. J., Borstlap, W. A. A., Consten, E. C. J., Veld, J. V., van Halsema, E. E., Bemelman, W. A., ... on behalf of the Dutch Snapshot Research Group (2019). Propensity score-matched analysis of oncological outcome between stent as bridge to surgery and emergency resection in patients with malignant left-sided colonic obstruction. British Journal of Surgery, 106(8), 1075-1086. https://doi.org/10.1002/bjs.11172
Amelung, F. J. ; Borstlap, W. A. A. ; Consten, E. C. J. ; Veld, J. V. ; van Halsema, E. E. ; Bemelman, W. A. ; Siersema, P. D. ; ter Borg, F. ; van Hooft, JE ; Tanis, PJ ; on behalf of the Dutch Snapshot Research Group. / Propensity score-matched analysis of oncological outcome between stent as bridge to surgery and emergency resection in patients with malignant left-sided colonic obstruction. In: British Journal of Surgery. 2019 ; Vol. 106, No. 8. pp. 1075-1086.
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title = "Propensity score-matched analysis of oncological outcome between stent as bridge to surgery and emergency resection in patients with malignant left-sided colonic obstruction",
abstract = "Background: Although self-expandable metal stent (SEMS) placement as bridge to surgery (BTS) in patients with left-sided obstructing colonic cancer has shown promising short-term results, it is used infrequently owing to uncertainty about its oncological safety. This population study compared long-term oncological outcomes between emergency resection and SEMS placement as BTS. Methods: Through a national collaborative research project, long-term outcome data were collected for all patients who underwent resection for left-sided obstructing colonic cancer between 2009 and 2016 in 75 Dutch hospitals. Patients were identified from the Dutch Colorectal Audit database. SEMS as BTS was compared with emergency resection in the curative setting after 1 : 2 propensity score matching. Results: Some 222 patients who had a stent placed were matched to 444 who underwent emergency resection. The overall SEMS-related perforation rate was 7·7 per cent (17 of 222). Three-year locoregional recurrence rates after SEMS insertion and emergency resection were 11·4 and 13·6 per cent (P = 0·457), disease-free survival rates were 58·8 and 52·6 per cent (P = 0·175), and overall survival rates were 74·0 and 68·3 per cent (P = 0·231), respectively. SEMS placement resulted in significantly fewer permanent stomas (23·9 versus 45·3 per cent; P < 0·001), especially in elderly patients (29·0 versus 57·9 per cent; P < 0·001). For patients in the SEMS group with or without perforation, 3-year locoregional recurrence rates were 18 and 11·0 per cent (P = 0·432), disease-free survival rates were 49 and 59·6 per cent (P = 0·717), and overall survival rates 61 and 75·1 per cent (P = 0·529), respectively. Conclusion: Overall, SEMS as BTS seems an oncologically safe alternative to emergency resection with fewer permanent stomas. Nevertheless, the risk of SEMS-related perforation, as well as permanent stoma, might influence shared decision-making for individual patients.",
author = "Amelung, {F. J.} and Borstlap, {W. A. A.} and Consten, {E. C. J.} and Veld, {J. V.} and {van Halsema}, {E. E.} and Bemelman, {W. A.} and Siersema, {P. D.} and {ter Borg}, F. and {van Hooft}, JE and PJ Tanis and Bakker, {I. S.} and {van den Berg}, A. and {den Boer}, {F. C.} and Brandsma, {H. T.} and L. Daniels and Heijnen, {B. H. M.} and Houdijk, {A. P. J.} and Kelling, {E. F.} and Lange, {J. F.} and Moes, {D. E.} and K. Nielsen and P. Poortman and Reiber, {B. M. M.} and Rutten, {H. J. T.} and C. Sietses and D. Smit and J. Straatman and M. Tenhagen and Tol, {J. A. M. G.} and Tuynman, {J. B.} and S. Veltkamp and {de Wilt}, {J. H. W.} and Bakker, {I. S.} and {van den Berg}, A. and {den Boer}, {F. C.} and Brandsma, {H. T.} and L. Daniels and Heijnen, {B. H. M.} and Houdijk, {A. P. J.} and Kelling, {E. F.} and Lange, {J. F.} and Moes, {D. E.} and K. Nielsen and P. Poortman and Reiber, {B. M. M.} and Rutten, {H. J. T.} and C. Sietses and D. Smit and J. Straatman and Tol, {J. A. M. G.} and Tuynman, {J. B.} and {de Wilt}, {J. H. W.} and {on behalf of the Dutch Snapshot Research Group}",
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Amelung, FJ, Borstlap, WAA, Consten, ECJ, Veld, JV, van Halsema, EE, Bemelman, WA, Siersema, PD, ter Borg, F, van Hooft, JE, Tanis, PJ & on behalf of the Dutch Snapshot Research Group 2019, 'Propensity score-matched analysis of oncological outcome between stent as bridge to surgery and emergency resection in patients with malignant left-sided colonic obstruction' British Journal of Surgery, vol. 106, no. 8, pp. 1075-1086. https://doi.org/10.1002/bjs.11172

Propensity score-matched analysis of oncological outcome between stent as bridge to surgery and emergency resection in patients with malignant left-sided colonic obstruction. / Amelung, F. J.; Borstlap, W. A. A.; Consten, E. C. J.; Veld, J. V.; van Halsema, E. E.; Bemelman, W. A.; Siersema, P. D.; ter Borg, F.; van Hooft, JE; Tanis, PJ; on behalf of the Dutch Snapshot Research Group.

In: British Journal of Surgery, Vol. 106, No. 8, 01.07.2019, p. 1075-1086.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Propensity score-matched analysis of oncological outcome between stent as bridge to surgery and emergency resection in patients with malignant left-sided colonic obstruction

AU - Amelung, F. J.

AU - Borstlap, W. A. A.

AU - Consten, E. C. J.

AU - Veld, J. V.

AU - van Halsema, E. E.

AU - Bemelman, W. A.

AU - Siersema, P. D.

AU - ter Borg, F.

AU - van Hooft, JE

AU - Tanis, PJ

AU - Bakker, I. S.

AU - van den Berg, A.

AU - den Boer, F. C.

AU - Brandsma, H. T.

AU - Daniels, L.

AU - Heijnen, B. H. M.

AU - Houdijk, A. P. J.

AU - Kelling, E. F.

AU - Lange, J. F.

AU - Moes, D. E.

AU - Nielsen, K.

AU - Poortman, P.

AU - Reiber, B. M. M.

AU - Rutten, H. J. T.

AU - Sietses, C.

AU - Smit, D.

AU - Straatman, J.

AU - Tenhagen, M.

AU - Tol, J. A. M. G.

AU - Tuynman, J. B.

AU - Veltkamp, S.

AU - de Wilt, J. H. W.

AU - Bakker, I. S.

AU - van den Berg, A.

AU - den Boer, F. C.

AU - Brandsma, H. T.

AU - Daniels, L.

AU - Heijnen, B. H. M.

AU - Houdijk, A. P. J.

AU - Kelling, E. F.

AU - Lange, J. F.

AU - Moes, D. E.

AU - Nielsen, K.

AU - Poortman, P.

AU - Reiber, B. M. M.

AU - Rutten, H. J. T.

AU - Sietses, C.

AU - Smit, D.

AU - Straatman, J.

AU - Tol, J. A. M. G.

AU - Tuynman, J. B.

AU - de Wilt, J. H. W.

AU - on behalf of the Dutch Snapshot Research Group

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Background: Although self-expandable metal stent (SEMS) placement as bridge to surgery (BTS) in patients with left-sided obstructing colonic cancer has shown promising short-term results, it is used infrequently owing to uncertainty about its oncological safety. This population study compared long-term oncological outcomes between emergency resection and SEMS placement as BTS. Methods: Through a national collaborative research project, long-term outcome data were collected for all patients who underwent resection for left-sided obstructing colonic cancer between 2009 and 2016 in 75 Dutch hospitals. Patients were identified from the Dutch Colorectal Audit database. SEMS as BTS was compared with emergency resection in the curative setting after 1 : 2 propensity score matching. Results: Some 222 patients who had a stent placed were matched to 444 who underwent emergency resection. The overall SEMS-related perforation rate was 7·7 per cent (17 of 222). Three-year locoregional recurrence rates after SEMS insertion and emergency resection were 11·4 and 13·6 per cent (P = 0·457), disease-free survival rates were 58·8 and 52·6 per cent (P = 0·175), and overall survival rates were 74·0 and 68·3 per cent (P = 0·231), respectively. SEMS placement resulted in significantly fewer permanent stomas (23·9 versus 45·3 per cent; P < 0·001), especially in elderly patients (29·0 versus 57·9 per cent; P < 0·001). For patients in the SEMS group with or without perforation, 3-year locoregional recurrence rates were 18 and 11·0 per cent (P = 0·432), disease-free survival rates were 49 and 59·6 per cent (P = 0·717), and overall survival rates 61 and 75·1 per cent (P = 0·529), respectively. Conclusion: Overall, SEMS as BTS seems an oncologically safe alternative to emergency resection with fewer permanent stomas. Nevertheless, the risk of SEMS-related perforation, as well as permanent stoma, might influence shared decision-making for individual patients.

AB - Background: Although self-expandable metal stent (SEMS) placement as bridge to surgery (BTS) in patients with left-sided obstructing colonic cancer has shown promising short-term results, it is used infrequently owing to uncertainty about its oncological safety. This population study compared long-term oncological outcomes between emergency resection and SEMS placement as BTS. Methods: Through a national collaborative research project, long-term outcome data were collected for all patients who underwent resection for left-sided obstructing colonic cancer between 2009 and 2016 in 75 Dutch hospitals. Patients were identified from the Dutch Colorectal Audit database. SEMS as BTS was compared with emergency resection in the curative setting after 1 : 2 propensity score matching. Results: Some 222 patients who had a stent placed were matched to 444 who underwent emergency resection. The overall SEMS-related perforation rate was 7·7 per cent (17 of 222). Three-year locoregional recurrence rates after SEMS insertion and emergency resection were 11·4 and 13·6 per cent (P = 0·457), disease-free survival rates were 58·8 and 52·6 per cent (P = 0·175), and overall survival rates were 74·0 and 68·3 per cent (P = 0·231), respectively. SEMS placement resulted in significantly fewer permanent stomas (23·9 versus 45·3 per cent; P < 0·001), especially in elderly patients (29·0 versus 57·9 per cent; P < 0·001). For patients in the SEMS group with or without perforation, 3-year locoregional recurrence rates were 18 and 11·0 per cent (P = 0·432), disease-free survival rates were 49 and 59·6 per cent (P = 0·717), and overall survival rates 61 and 75·1 per cent (P = 0·529), respectively. Conclusion: Overall, SEMS as BTS seems an oncologically safe alternative to emergency resection with fewer permanent stomas. Nevertheless, the risk of SEMS-related perforation, as well as permanent stoma, might influence shared decision-making for individual patients.

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UR - https://www.ncbi.nlm.nih.gov/pubmed/31074507

U2 - 10.1002/bjs.11172

DO - 10.1002/bjs.11172

M3 - Article

VL - 106

SP - 1075

EP - 1086

JO - British Journal of Surgery

JF - British Journal of Surgery

SN - 0007-1323

IS - 8

ER -