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Research article
Bujun Ge
Tongji University School of Medicine
Corresponding Author
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Purpose
Bridge to elective surgery (BTS) using self-expanding metal stents (SEMS) is a common alternative to emergency surgery (ES) for acute malignant left-sided colonic obstruction (AMLCO). However, the study regarding long-term impact of BTS is limited and unclear.
Methods
A multicenter observational study was performed at three hospitals from April 2012 to December 2019. Propensity score matching (PSM) was introduced to minimize selection bias. The primary endpoint was overall survival. The secondary endpoints included surgical approaches, primary resection types, total stent related adverse effects (AEs), surgical AEs, length of hospital stay, 30-day mortality and tumor recurrence.
Results
49 patients in both BTS and ES group were matched. Patients in the BTS group more often underwent laparoscopic resection (31 [63.3%] vs 8 [16.3%], p<0.001), less likely to have a primary stoma (13 [26.5%] vs 26 [53.1%], p=0.007) and more often had perineural invasion (25 [51.0%] vs 13 [26.5%], p=0.013). The median overall survival was significantly lower in patients with stent insertion (41 vs 65 months, p=0.041). 3-year overall survival (53.0% vs 77.2%, p=0.039) and 5-year overall survival (30.6% vs 55.0%, p=0.025) were significantly less favorable in the BTS group. In the multivariate Cox regression analysis, stenting (hazard ratio(HR)= 2.309(1.052-5.066), p=0.037), surgical AEs (HR=1.394(1.053-1.845), p=0.020) and pTNM stage (HR=1.706(1.116-2.607), p=0.014) were positively correlated with overall survival in matched patients.
Conclusions
Self-expanding metal stents as “a bridge to surgery” is associated with more perineural invasion, higher recurrence rate and worse overall survival in patients with acute malignant left-sided colonic obstruction compared with emergency surgery.
Keywords
acute malignant left-sided colonic obstruction, self-expanding metallic stent, propensity score matching, overall survival
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CURRENT STATUS: Published
View the published article at BMC Surgery.
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Posted 23 Nov, 2020
No community comments so far
Editorial decision: Major revision
On 04 Jan, 2021
Review #1 received
Received 30 Dec, 2020
Review #2 received
Received 23 Dec, 2020
Reviewer #2 agreed
On 16 Dec, 2020
Reviewers invited
Invitations sent on 10 Dec, 2020
Reviewer #1 agreed
On 10 Dec, 2020
First submitted
On 02 Nov, 2020
Editor assigned
On 02 Nov, 2020
Submission checks complete
On 02 Nov, 2020
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On 02 Nov, 2020
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at BMC Surgery.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Bujun Ge
Tongji University School of Medicine
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Surgery.
Version 1
Posted 23 Nov, 2020
No community comments so far
Editorial decision: Major revision
On 04 Jan, 2021
Review #1 received
Received 30 Dec, 2020
Review #2 received
Received 23 Dec, 2020
Reviewer #2 agreed
On 16 Dec, 2020
Reviewers invited
Invitations sent on 10 Dec, 2020
Reviewer #1 agreed
On 10 Dec, 2020
First submitted
On 02 Nov, 2020
Editor assigned
On 02 Nov, 2020
Submission checks complete
On 02 Nov, 2020
Editor invited
On 02 Nov, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Surgery.
Purpose
Bridge to elective surgery (BTS) using self-expanding metal stents (SEMS) is a common alternative to emergency surgery (ES) for acute malignant left-sided colonic obstruction (AMLCO). However, the study regarding long-term impact of BTS is limited and unclear.
Methods
A multicenter observational study was performed at three hospitals from April 2012 to December 2019. Propensity score matching (PSM) was introduced to minimize selection bias. The primary endpoint was overall survival. The secondary endpoints included surgical approaches, primary resection types, total stent related adverse effects (AEs), surgical AEs, length of hospital stay, 30-day mortality and tumor recurrence.
Results
49 patients in both BTS and ES group were matched. Patients in the BTS group more often underwent laparoscopic resection (31 [63.3%] vs 8 [16.3%], p<0.001), less likely to have a primary stoma (13 [26.5%] vs 26 [53.1%], p=0.007) and more often had perineural invasion (25 [51.0%] vs 13 [26.5%], p=0.013). The median overall survival was significantly lower in patients with stent insertion (41 vs 65 months, p=0.041). 3-year overall survival (53.0% vs 77.2%, p=0.039) and 5-year overall survival (30.6% vs 55.0%, p=0.025) were significantly less favorable in the BTS group. In the multivariate Cox regression analysis, stenting (hazard ratio(HR)= 2.309(1.052-5.066), p=0.037), surgical AEs (HR=1.394(1.053-1.845), p=0.020) and pTNM stage (HR=1.706(1.116-2.607), p=0.014) were positively correlated with overall survival in matched patients.
Conclusions
Self-expanding metal stents as “a bridge to surgery” is associated with more perineural invasion, higher recurrence rate and worse overall survival in patients with acute malignant left-sided colonic obstruction compared with emergency surgery.
Figure 1
Figure 2
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