title: Is stenting as "a bridge to surgery" an oncologically safe strategy for the management of acute, left-sided, malignant, colonic obstruction? A comparative study with a propensity score analysis.
abstract: OBJECTIVE
  Self-expanding metallic stent (SEMS) insertion has been suggested as a promising alternative to emergency surgery for left-sided malignant colonic obstruction (LMCO). However, the literature on the long-term impact of SEMS as "a bridge to surgery" is limited and contradictory.
  
  
  METHODS
  From January 1998 to June 2011, we retrospectively identified patients operated on for LMCO with curative intent. The primary outcome criterion was overall survival. Short-term secondary endpoints included the technical success rate and overall success rate and long-term secondary endpoints included 5-year overall survival, 5-year cancer-specific mortality, 5-year disease-free survival, the recurrence rate, and mean time to recurrence. Patients treated with SEMS were analyzed on an intention-to-treat basis. Overall survival was analyzed after using a propensity score to correct for selection bias.
  
  
  RESULTS
  There were 48 patients in the SEMS group and 39 in the surgery-only group. In the overall population, overall survival (P = 0.001) and 5-year overall survival (P = 0.0003) were significantly lower in the SEMS group than in the surgery-only group, and 5-year cancer-specific mortality was significantly higher in the SEMS group (48% vs 21%, respectively (P = 0.02)). Five-year disease-free survival, the recurrence rate, and the mean time to recurrence were better in the surgery-only group (not significant). For patients with no metastases or perforations at hospital admission, overall survival (P = 0.003) and 5-year overall survival (30% vs 67%, respectively, P = 0.001) were significantly lower in the SEMS group than in the surgery-only group.
  
  
  CONCLUSIONS
  Our study results suggest worse overall survival of patients with LMCO with SEMS insertion compared with immediate surgery.
authors: Department of Digestive and Metabolic Surgery, North Hospital, Amiens University Medical Center, place Victor Pauchet, Amiens, France.
authors: Charles
authors: C
authors: Sabbagh
authors: François
authors: F
authors: Browet
authors: Momar
authors: M
authors: Diouf
authors: Cyril
authors: C
authors: Cosse
authors: Olivier
authors: O
authors: Brehant
authors: Eric
authors: E
authors: Bartoli
authors: François
authors: F
authors: Mauvais
authors: Bruno
authors: B
authors: Chauffert
authors: Jean-Louis
authors: JL
authors: Dupas
authors: Eric
authors: E
authors: Nguyen-Khac
authors: Jean-Marc
authors: JM
authors: Regimbeau
mesh_terms: D000230:Adenocarcinoma / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D000368:Aged; D016009:Chi-Square Distribution; D003110:Colonic Neoplasms / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D008297:Male; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome