Comparison between metallic stent and transanal decompression tube for malignant large-bowel obstruction

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• 作者：Akihisa Matsuda ; MD^a ; ^{a-matsu@nms.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Masao Miyashita ; MD^a ; Satoshi Matsumoto ; MD^a ; Nobuyuki Sakurazawa ; MD^a ; Goro Takahashi ; MD^a ; Takeshi Matsutani ; MD^b ; Marina Yamada ; PhD^a ; Eiji Uchida ; MD^b
• 关键词：Colorectal cancer ; Obstruction ; Self-expandable metallic colonic stent ; Bridge to surgery ; Transanal decompression tube
• 刊名：Journal of Surgical Research
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：205
• 期：2
• 页码：474-481
• 全文大小：399 K

文摘

The short-term safety and efficacy of a self-expandable metallic colonic stent (SEMS) insertion followed by elective surgery, “bridge to surgery (BTS)”, for malignant large-bowel obstruction (MLBO) have been well described comparing with emergency surgery. The aim of this study was to compare short-term outcomes of endoscopic decompression using a SEMS versus a transanal decompression tube (TDT).

Materials and methods

From January 2005 to November 2014, a total of 101 patients with MLBO underwent surgery at our single institution were retrospectively identified. Among them, 73 patients who underwent preoperative complete insertion of a decompression device (TDT, n = 45; SEMS, n = 28) were finally included in this study. Six patients with incomplete insertion of a decompression device (TDT, n = 5; SEMS, n = 1) were also excluded. The primary endpoints of this study were the postoperative morbidity and mortality rates. The secondary endpoints were decompression-related outcomes. Additionally, propensity score matched (PSM) analysis was conducted in short-term outcomes between the groups.

Results

The SEMS group had significantly higher proportion of right-sided tumor and bigger tumor size compared with those of the TDT group. The SEMS group had a significantly higher proportion of patients who underwent laparoscopic surgery, and consequently, a longer surgical duration than did the TDT group. Higher rates of insertion failure and perforation were recognized in the TDT group than in the SEMS group (10.0% versus 3.6% and 8.9% versus 0.0%, respectively), although these differences were not statistically significant (P = 0.406 and 0.291, respectively). The two groups showed similar occurrences of anastomotic leakage, bowel obstruction, overall complications, and mortality. Compared with the TDT group, the SEMS group had a significantly lower rate of surgical site infection (24.4% versus 3.6%, respectively; P = 0.023 and P = 0.025 after PSM) and a shorter length of hospital stay (median, 21 d [interquartile range, 18-29 d] versus 38 d [interquartile range, 28-45 d], respectively; P = 0.015 and P = 0.003 after PSM). Solid food intake after decompression and preoperative temporary discharge occurred only in the SEMS group.

Conclusions

Preoperative SEMS insertion for MLBO is effective with at least equivalent short-term outcomes and superior preoperative quality of life compared with decompression using TDT.