TY - JOUR
T1 - Time interval between self-expandable metal stent placement or creation of a decompressing stoma and elective resection of left-sided obstructive colon cancer
AU - Veld, Joyce Valerie
AU - Kumcu, Aydan
AU - Amelung, Femke Julie
AU - Borstlap, Wernard Aat Antoine
AU - Consten, Esther Catharina Josephina
AU - Dekker, Jan Willem Teunis
AU - Van Westreenen, Henderik Leendert
AU - Siersema, Peter D.
AU - Ter Borg, Frank
AU - Kusters, Miranda
AU - Bemelman, Wilhelmus Adrianus
AU - De Wilt, Johannes Hendrik Willem
AU - Van Hooft, Jeanin E.
AU - Tanis, Pieter Job
N1 - Funding Information: Outside of the submitted work, J.E. van Hooft received a grant from Cook Medicals and a consultancy fee from Boston Scientific and Med-tronics; P.D. Siersema receives grant support from Pentax Medical, Norgine, EndoStim, and Motus GI, and is on the advisory board of Pentax, Ella-CS, and Boston Scientific. The authors declare that they have no conflict of interest. Funding Information: The study was funded by unrestricted research grants from Ci-trienfonds and the Dutch Cancer Society (KWF). The authors would like to thank Dr. S. van Dieren, clinical epidemiologist, for her advice on the statistical analyses. Publisher Copyright: © 2020. Thieme. All rights reserved.
PY - 2021/9/1
Y1 - 2021/9/1
N2 - Background: The optimal timing of resection after decompression of left-sided obstructive colon cancer is unknown. Revised expert-based guideline recommendations have shifted from an interval of 5-10 days to approximately 2 weeks following self-expandable metal stent (SEMS) placement, and recommendations after decompressing stoma are lacking. We aimed to evaluate the recommended bridging intervals after SEMS and explore the timing of resection after decompressing stoma. Methods: This nationwide study included patients registered between 2009 and 2016 in the prospective, mandatory Dutch ColoRectal Audit. Additional data were collected through patient records in 75 hospitals. Only patients who underwent either SEMS placement or decompressing stoma as a bridge to surgery were selected. Technical SEMS failure and unsuccessful decompression within 48 hours were exclusion criteria. Results: 510 patients were included (182 SEMS, 328 decompressing stoma). Median bridging interval was 23 days (interquartile range [IQR] 13-31) for SEMS and 36 days (IQR 22-65) for decompressing stoma. Following SEMS placement, no significant differences in post-resection complications, hospital stay, or laparoscopic resections were observed with resection after 11-17 days compared with 5-10 days. Of SEMS-related complications, 48% occurred in patients operated on beyond 17 days. Compared with resection within 14 days, an interval of 14-28 days following decompressing stoma resulted in significantly more laparoscopic resections, more primary anastomoses, and shorter hospital stays. No impact of bridging interval on mortality, disease-free survival, or overall survival was demonstrated. Conclusions: Based on an overview of the data with balancing of surgical outcomes and timing of adverse events, a bridging interval of approximately 2 weeks seems appropriate after SEMS placement, while waiting 2-4 weeks after decompressing stoma further optimizes surgical conditions for laparoscopic resection with restoration of bowel continuity.
AB - Background: The optimal timing of resection after decompression of left-sided obstructive colon cancer is unknown. Revised expert-based guideline recommendations have shifted from an interval of 5-10 days to approximately 2 weeks following self-expandable metal stent (SEMS) placement, and recommendations after decompressing stoma are lacking. We aimed to evaluate the recommended bridging intervals after SEMS and explore the timing of resection after decompressing stoma. Methods: This nationwide study included patients registered between 2009 and 2016 in the prospective, mandatory Dutch ColoRectal Audit. Additional data were collected through patient records in 75 hospitals. Only patients who underwent either SEMS placement or decompressing stoma as a bridge to surgery were selected. Technical SEMS failure and unsuccessful decompression within 48 hours were exclusion criteria. Results: 510 patients were included (182 SEMS, 328 decompressing stoma). Median bridging interval was 23 days (interquartile range [IQR] 13-31) for SEMS and 36 days (IQR 22-65) for decompressing stoma. Following SEMS placement, no significant differences in post-resection complications, hospital stay, or laparoscopic resections were observed with resection after 11-17 days compared with 5-10 days. Of SEMS-related complications, 48% occurred in patients operated on beyond 17 days. Compared with resection within 14 days, an interval of 14-28 days following decompressing stoma resulted in significantly more laparoscopic resections, more primary anastomoses, and shorter hospital stays. No impact of bridging interval on mortality, disease-free survival, or overall survival was demonstrated. Conclusions: Based on an overview of the data with balancing of surgical outcomes and timing of adverse events, a bridging interval of approximately 2 weeks seems appropriate after SEMS placement, while waiting 2-4 weeks after decompressing stoma further optimizes surgical conditions for laparoscopic resection with restoration of bowel continuity.
UR - http://www.scopus.com/inward/record.url?scp=85098219532&partnerID=8YFLogxK
U2 - https://doi.org/10.1055/a-1308-1487
DO - https://doi.org/10.1055/a-1308-1487
M3 - Article
C2 - 33339059
SN - 0013-726X
VL - 53
SP - 905
EP - 913
JO - Endoscopy
JF - Endoscopy
IS - 9
ER -