Retrospective Study
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World J Gastroenterol. Sep 7, 2014; 20(33): 11826-11834
Published online Sep 7, 2014. doi: 10.3748/wjg.v20.i33.11826
Surgical failure after colonic stenting as a bridge to surgery
Jung Ho Kim, Kwang An Kwon, Jong Joon Lee, Won-Suk Lee, Jeong-Heum Baek, Yoon Jae Kim, Jun-Won Chung, Kyoung Oh Kim, Dong Kyun Park, Ju Hyun Kim
Jung Ho Kim, Kwang An Kwon, Jong Joon Lee, Yoon Jae Kim, Jun-Won Chung, Kyoung Oh Kim, Dong Kyun Park, Ju Hyun Kim, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 405760, South Korea
Won-Suk Lee, Jeong-Heum Baek, Department of Surgery, Gachon University Gil Medical Center, Incheon 405760, South Korea
Author contributions: Kim JH and Kwon KA designed the research; Lee WS and Baek JH performed the research; Kim YJ and Kim KO collected the data; Chung JW and Park DK analyzed the data; Kwon KA and Kim JH coordinated and supported the statistical analysis; Kim JH wrote the paper; Lee JJ provided critical revision of the manuscript.
Supported by A grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute, funded by the Ministry of Health and Fare, Republic of Korea, No. HI13C-1602-010013; grants of the Gachon University Gil Medical Center, No. 2013-01 and 2013-37
Correspondence to: Kwang An Kwon, MD, PhD, Department of Internal Medicine, Gachon University Gil Medical center, 1198, Guwol-dong, Namdong-Gu, Incheon 405760, South Korea. toptom@gilhospital.com
Telephone: +82-32-4603778 Fax: +82-32-4603408
Received: January 27, 2014
Revised: March 26, 2014
Accepted: April 21, 2014
Published online: September 7, 2014
Abstract

AIM: To identify risk factors for surgical failure after colonic stenting as a bridge to surgery in left-sided malignant colonic obstruction.

METHODS: The medical records of patients who underwent stent insertion for malignant colonic obstruction between February 2004 and August 2012 were retrospectively reviewed. Patients with malignant colonic obstruction had overt clinical symptoms and signs of obstruction. Malignant colonic obstruction was diagnosed by computed tomography and colonoscopy. A total of 181 patients underwent stent insertion during the study period; of these, 68 consecutive patients were included in our study when they had undergone stent placement as a bridge to surgery in acute left-sided malignant colonic obstruction due to primary colon cancer.

RESULTS: Out of 68 patients, forty-eight (70.6%) were male, and the mean age was 64.9 (range, 38-89) years. The technical and clinical success rates were 97.1% (66/68) and 88.2% (60/68), respectively. Overall, 85.3% (58/68) of patients underwent primary tumor resection and primary anastomosis. Surgically successful preoperative colonic stenting was achieved in 77.9% (53/68). The mean duration, defined as the time between the SEMS attempt and surgery, was 11.3 d (range, 0-26 d). The mean hospital stay after surgery was 12.5 d (range, 6-55 d). On multivariate analysis, the use of multiple self-expanding metal stents (OR = 28.872; 95%CI: 1.939-429.956, P = 0.015) was a significant independent risk factor for surgical failure of preoperative stenting as a bridge to surgery. Morbidity and mortality rates in surgery after stent insertion were 4.4% (3/68) and 1.5% (1/68), respectively.

CONCLUSION: The use of multiple self-expanding metal stents appears to be a risk factor for surgical failure.

Keywords: Colorectal neoplasms, Endoscopy, Intestinal obstruction, Risk factors, Stents

Core tip: When self-expanding metal stents (SEMS) is used as a bridge to surgery, the goal is a successful surgical outcome. When surgical results are not good after colonic stenting in patients with malignant colonic obstruction (MCO), many physicians have wondered about the risk factors of surgical failure and wanted to improve their results. Our results show that the use of multiple SEMS was an independent risk factor for surgical failure on multivariate analysis. The identification of this risk factor might help physicians make decisions regarding an appropriate modality for patients with acute left-sided MCO and should provide a foundation for establishing a consensus on treatment strategies in these patients.