Background and aim: Emergency surgery for left-sided colorectal cancer obstruction (LCCO) is associated with high mortality and morbidity. Selfexpanding metal stent (SEMS) placement as “bridge to surgery” may reduce mortality and morbidity, but data are controversial. We aimed to evaluate the mortality and morbidity both operative and predicted by Portsmouth-POSSUM (P-P) and colorectal-POSSUM (CR-P) of “bridge to surgery” strategy versus Emergency surgery in patients with LCCO. Material and methods: From January 2008 to December 2009 all consecutive patients with LCCO underwent SEMS placement as “bridge to surgery” (group A) or directly Emergency surgery (group B). Physiologic and operative scores of the P-P and CR-P systems were calculated and predicted P-P and CR-P mortality and morbidity was evaluated. Mortality and morbidity within 30 days after surgery were recorded. Results: Eighty-six patients were enrolled: 45 in group A (19 M, mean age 71 years) and 41 in group B (20 M, mean age 74 years). The mean baseline Physiologic Score of P-P (A=26.2 vs B=26; p=NS) and CR-P (group A=11.2 vs group B=11.9; p=NS) was no different between the two groups. The “bridge to surgery” strategy yielded a significant reduction of the mean Physiologic Score of P-P (from 26.2 to 19.2, p=0.001) and CR-P (from 11.2 to 10.1, p=0.01) before elective surgery. Group A showed a significant lower mean Operative Score of P-P (11.1 vs 15; p=0.001) and CR-P (7.5 vs 9.6; p=0.01) when compared with group B. The mortality both operative (A=2.4% (1/45) vs B=9.8% (4/41); p=0.18) and predicted by P-P (A=2.4% (1/45) vs B=13.6% (5/41); p=0.09) and CR-P (A=4.9% (2/45) vs B=15.1% (6/41); p=0.14) was lower in the group A than in group B, although not statistical significant. A statistical significant reduction of morbidity both operative (A=29% (13/45) vs B=61% (25/41); p=0.005) and predicted by P-P (A=34.3% (15/45) vs B=70.5% (28/41); p=0.002) was observed in the group A. Conclusions: SEMS placement as “bridge to surgery” is a safer option in surgery of patients with LCCO. It improves pre-operative physiologic factors and reduces intra-operative risk factors reducing post-operative mortality and morbidity.
Vincenzo, C., Luigiano, C., Ansaloni, L., Coccolini, F., Fuccio, L., Fabbri, C., et al. (2011). A COLONIC SELF-EXPANDING METAL STENT PLACEMENT AS "BRIDGE TO SURGERY" IS THE SAFEST STRATEGY IN THE MANAGEMENT OF PATIENTS WITH LEFT-SIDED COLON CANCER OBSTRUCTION. DIGESTIVE AND LIVER DISEASE, 43, S164-S164 [10.1016/S1590-8658(11)60275-2].
A COLONIC SELF-EXPANDING METAL STENT PLACEMENT AS "BRIDGE TO SURGERY" IS THE SAFEST STRATEGY IN THE MANAGEMENT OF PATIENTS WITH LEFT-SIDED COLON CANCER OBSTRUCTION
Ansaloni, L;Coccolini, F;Fuccio, L;Fabbri, C;Casetti, T;Pinna, AD;Zagari, RM;Bazzoli, F
2011
Abstract
Background and aim: Emergency surgery for left-sided colorectal cancer obstruction (LCCO) is associated with high mortality and morbidity. Selfexpanding metal stent (SEMS) placement as “bridge to surgery” may reduce mortality and morbidity, but data are controversial. We aimed to evaluate the mortality and morbidity both operative and predicted by Portsmouth-POSSUM (P-P) and colorectal-POSSUM (CR-P) of “bridge to surgery” strategy versus Emergency surgery in patients with LCCO. Material and methods: From January 2008 to December 2009 all consecutive patients with LCCO underwent SEMS placement as “bridge to surgery” (group A) or directly Emergency surgery (group B). Physiologic and operative scores of the P-P and CR-P systems were calculated and predicted P-P and CR-P mortality and morbidity was evaluated. Mortality and morbidity within 30 days after surgery were recorded. Results: Eighty-six patients were enrolled: 45 in group A (19 M, mean age 71 years) and 41 in group B (20 M, mean age 74 years). The mean baseline Physiologic Score of P-P (A=26.2 vs B=26; p=NS) and CR-P (group A=11.2 vs group B=11.9; p=NS) was no different between the two groups. The “bridge to surgery” strategy yielded a significant reduction of the mean Physiologic Score of P-P (from 26.2 to 19.2, p=0.001) and CR-P (from 11.2 to 10.1, p=0.01) before elective surgery. Group A showed a significant lower mean Operative Score of P-P (11.1 vs 15; p=0.001) and CR-P (7.5 vs 9.6; p=0.01) when compared with group B. The mortality both operative (A=2.4% (1/45) vs B=9.8% (4/41); p=0.18) and predicted by P-P (A=2.4% (1/45) vs B=13.6% (5/41); p=0.09) and CR-P (A=4.9% (2/45) vs B=15.1% (6/41); p=0.14) was lower in the group A than in group B, although not statistical significant. A statistical significant reduction of morbidity both operative (A=29% (13/45) vs B=61% (25/41); p=0.005) and predicted by P-P (A=34.3% (15/45) vs B=70.5% (28/41); p=0.002) was observed in the group A. Conclusions: SEMS placement as “bridge to surgery” is a safer option in surgery of patients with LCCO. It improves pre-operative physiologic factors and reduces intra-operative risk factors reducing post-operative mortality and morbidity.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
