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- Title
Perioperative and oncologic outcomes of interval colectomy performed by acute care surgeons after stenting as a bridge to surgery for left-sided malignant colonic obstruction are non-inferior to the outcomes of colorectal surgeons in the elective setting: single center experience
- Authors
Aranda-Narváez, J. M.; González-Cano, J.; González-Sánchez, A. J.; Titos-García, A.; Cabrera-Serna, I.; Romacho-López, L.; González-Poveda, I.; Mera-Velasco, S; Vázquez-Pedreño, L.; Santoyo-Santoyo, J.
- Abstract
Purpose: To analyze if perioperative and oncologic outcomes with stenting as a bridge to surgery (SEMS-BS) and interval colectomy performed by acute care surgeons for left-sided occlusive colonic neoplasms (LSCON) are non-inferior to those obtained by colorectal surgeons for non-occlusive tumors of the same location in the full-elective context. Methods: From January 2011 to January 2021, patients with LSCON at University Regional Hospital in Málaga (Spain) were directed to a SEMS-BS strategy with an interval colectomy performed by acute care surgeons and included in the study group (SEMS-BS). The control group was formed with patients from the Colorectal Division elective surgical activity dataset, matching by ASA, stage, location and year of surgery on a ratio 1:2. Stages IV or palliative stenting were excluded. Software SPSS 23.0 was used to analyze perioperative and oncologic (defined by overall -OS- and disease free -DFS-survival) outcomes. Results: SEMS-BS and control group included 56 and 98 patients, respectively. In SEMS-BS group, rates of technical/clinical failure and perforation were 5.35% (3/56), 3.57% (2/56) and 3.57% (2/56). Surgery was performed with a median interval time of 11 days (9–16). No differences between groups were observed in perioperative outcomes (laparoscopic approach, primary anastomosis rate, morbidity or mortality). As well, no statistically significant differences were observed in OS and DFS between groups, both compared globally (OS:p < 0.94; DFS:p < 0.67, respectively) or by stages I–II (OS:p < 0.78; DFS:p < 0.17) and III (OS:p < 0.86; DFS:p < 0.70). Conclusion: Perioperative and oncologic outcomes of a strategy with SEMS-BS for LSCON are non-inferior to those obtained in the elective setting for non-occlusive neoplasms in the same location. Technical and oncologic safety of interval colectomy performed on a semi-scheduled situation by acute care surgeons is absolutely warranted.
- Subjects
SPAIN; COLON tumors; BOWEL obstructions; STATISTICAL significance; CONFIDENCE intervals; COLECTOMY; LOG-rank test; MULTIVARIATE analysis; MORTALITY; SURGICAL stents; RETROSPECTIVE studies; REGRESSION analysis; MANN Whitney U Test; FISHER exact test; DISEASES; TREATMENT effectiveness; T-test (Statistics); KAPLAN-Meier estimator; CHI-squared test; SURVIVAL analysis (Biometry); STATISTICAL models; DATA analysis software; COMPUTED tomography; PROGRESSION-free survival; PROPORTIONAL hazards models; ALGORITHMS
- Publication
European Journal of Trauma & Emergency Surgery, 2022, Vol 48, Issue 6, p4651
- ISSN
1863-9933
- Publication type
Article
- DOI
10.1007/s00068-022-02015-9