Published online Apr 28, 2019. doi: 10.3748/wjg.v25.i16.1975
Peer-review started: December 6, 2018
First decision: January 11, 2019
Revised: January 25, 2019
Accepted: January 28, 2019
Article in press: January 28, 2019
Published online: April 28, 2019
Emergency surgical resection is a standard treatment for right-sided malignant colonic obstruction; however, the procedure is associated with high rates of mortality and morbidity. Although a bridge to surgery can be created to obviate the need for emergency surgery, its effects on long-term outcomes and the most practical management strategies for right-sided malignant colonic obstruction remain unclear.
To determine the appropriate management approach for right-sided malignant colonic obstruction.
Forty patients with right-sided malignant colonic obstruction who underwent curative resection from January 2007 to April 2017 were included in the study. We compared the perioperative and long-term outcomes of patients who received bridges to surgery established using decompression tubes and those created using self-expandable metallic stents (SEMS). The primary outcome was the overall survival duration (OS) and the secondary endpoints were the disease-free survival (DFS) duration and the preoperative and postoperative morbidity rates. Analysis was performed on an intention-to-treat basis.
There were 21 patients in the decompression tube group and 19 in the SEMS group. There were no significant differences in the perioperative morbidity rates of the two groups. The OS rate was significantly higher in the decompression tube group than in the SEMS group (5-year OS rate; decompression tube 79.5%, SEMS 32%, P = 0.043). Multivariate analysis revealed that the bridge to surgery using a decompression tube was significantly associated with the OS (hazard ratio, 17.41; P = 0.004). The 3-year DFS rate was significantly higher in the decompression tube group than in the SEMS group (68.9% vs 45.9%; log-rank test, P = 0.032). A propensity score–adjusted analysis also demonstrated that the prognosis was significantly better in the decompression tube group than in the SEMS group.
The bridge to surgery using trans-nasal and trans-anal decompression tubes for right-sided malignant colonic obstruction is safe and may improve long-term outcomes.
Core tip: Patients with malignant colonic obstructions typically undergo emergency surgery, which is associated with high rates of mortality and morbidity. To overcome this, bridges to surgery have been proposed, but their efficacy in patients with right-sided malignant colonic obstructions remains unclear, mainly because obstructions are less common in patients with right- than left-sided colon cancer. We compared two bridges to surgery: Decompression tubes and self-expandable metallic stents. The short-term outcomes of the two groups did not differ, but the overall survival and disease-free survival rates were better in the former patients, suggesting that decompression tube placement may be optimal.