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
As the incidence of obstruction with left-sided colon cancer is reportedly higher than that in right-sided colon cancer, there is a lack of data regarding the management of right-sided malignant colonic obstruction (RMCO).
Although emergency surgery is a standard treatment for malignant colonic obstruction, the efficacy of bridges to surgery using self-expandable metallic stents (SEMS) or decompression tubes has only recently been evaluated.
To evaluate the optimum management strategy for patients with RMCO by comparing the perioperative and oncologic outcomes of bridges to surgery using decompression tubes and metallic stents.
This was a single-center, retrospective observational study. The subjects were patients diagnosed with RMCO who underwent curative surgical resection. We compared patients who were preoperatively treated with SEMS to those treated with decompression tubes. The primary endpoint was the overall survival (OS) duration on an intention-to-treat basis and the secondary endpoints were the disease-free survival (DFS) duration and the preoperative and postoperative morbidity rates. In addition, to reduce the likelihood of selection bias, we applied inverse propensity scores as weights.
There was no significant difference in perioperative morbidity rate between the two groups. The OS rate was significantly higher in the decompression tube group than the SEMS group (5-year OS rates of 79.5 and 32%, respectively, 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 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 results of this study suggest that patients with RMCO who received a bridge to surgery using a trans-nasal or trans-nasal decompression tube had better outcomes; these results were confirmed statistically in a multivariate analysis using the stepwise method and propensity score adjustment.
Because this study used a single-center retrospective design and included relatively few patients, further investigations, such as a multi-center randomized controlled study, are needed. In addition, as the decompression tubes can make patients uncomfortable, a study including quality of life measures is desirable.