Bridge-to-surgery versus emergency surgery in the management of left-sided acute malignant colorectal obstruction - Efficacy, safety and long-term outcomes.
OBJECTIVE
Compare efficacy, safety and long-term outcomes of bridge-to-surgery and emergency surgery in acute malignant colorectal obstruction.


METHODS
Retrospective study of 94 consecutive patients with left-sided acute malignant colorectal obstruction treated with curative intent between 2010-2017.


RESULTS
48 patients underwent stent placement and 46 underwent emergency surgery. Technical and clinical success were 100% and 87%. Laparoscopy and one-staged operation were more frequent in bridge-to-surgery (44% vs 2%, p < 0.001; 73% vs 30%, p < 0.001). Fewer permanent stomas were created in bridge-to-surgery (15% vs 35%, p = 0.013). Overall morbidity was 36%. Immediate and post-procedure stent related-complications occurred in 6% and 13%; surgery-related complications occurred in 28% (bridge-to-surgery: 15% vs emergency surgery: 41%, p = 0.004). No differences were found regarding tumor recurrence, recurrence-free survival and overall survival. R1 resection (HR 47.2, 95%CI:4.1-543.7), number of lymph nodes harvested (HR 0.9 95%CI:0.8-0.99) and adjuvant therapy (HR 0.1 95%CI:0.01-0.9) predicted recurrence-free survival; pTMN stage IV (HR 7.3, 95%CI:1.1-47.6), number of lymph nodes harvested (HR 0.90, 95%CI:0.8-0.97), adjuvant therapy (HR 0.1, 95%CI:0.02-0.4) and surgery-related complications (HR 5.3, 95%CI:1.02-27.3) influenced overall survival.


CONCLUSION
Stent placement has a high success, similarly to emergency surgery, being associated with higher primary anastomosis and lower stoma rates. Tumor recurrence rate, recurrence-free survival and overall survival were comparable between groups; surgery-related complications influenced overall survival.
['Rodrigues-Pinto|Eduardo|E|', 'Morais|Rui|R|', 'Coelho|Catarina|C|', 'Pereira|Pedro|P|', 'Repici|Alessandro|A|', 'Macedo|Guilherme|G|']
D000368:Aged D000369:Aged, 80 and over D000714:Anastomosis, Surgical D015179:Colorectal Neoplasms D004638:Emergency Treatment D005260:Female D006801:Humans D007415:Intestinal Obstruction D010535:Laparoscopy D008297:Male D008875:Middle Aged D015999:Multivariate Analysis D009364:Neoplasm Recurrence, Local D011174:Portugal D012189:Retrospective Studies D015607:Stents D016019:Survival Analysis D062606:Tertiary Care Centers
Bridge-to-surgery Emergent surgery Acute malignant colorectal obstruction Self-expandable metal stent