Comparison between metallic stent and transanal decompression tube for malignant large-bowel obstruction.
The short-term safety and efficacy of a self-expandable metallic colonic stent (SEMS) insertion followed by elective surgery, "bridge to surgery (BTS)", for malignant large-bowel obstruction (MLBO) have been well described comparing with emergency surgery. The aim of this study was to compare short-term outcomes of endoscopic decompression using a SEMS versus a transanal decompression tube (TDT).



From January 2005 to November 2014, a total of 101 patients with MLBO underwent surgery at our single institution were retrospectively identified. Among them, 73 patients who underwent preoperative complete insertion of a decompression device (TDT, n = 45; SEMS, n = 28) were finally included in this study. Six patients with incomplete insertion of a decompression device (TDT, n = 5; SEMS, n = 1) were also excluded. The primary endpoints of this study were the postoperative morbidity and mortality rates. The secondary endpoints were decompression-related outcomes. Additionally, propensity score matched (PSM) analysis was conducted in short-term outcomes between the groups.



The SEMS group had significantly higher proportion of right-sided tumor and bigger tumor size compared with those of the TDT group. The SEMS group had a significantly higher proportion of patients who underwent laparoscopic surgery, and consequently, a longer surgical duration than did the TDT group. Higher rates of insertion failure and perforation were recognized in the TDT group than in the SEMS group (10.0% versus 3.6% and 8.9% versus 0.0%, respectively), although these differences were not statistically significant (P = 0.406 and 0.291, respectively). The two groups showed similar occurrences of anastomotic leakage, bowel obstruction, overall complications, and mortality. Compared with the TDT group, the SEMS group had a significantly lower rate of surgical site infection (24.4% versus 3.6%, respectively; P = 0.023 and P = 0.025 after PSM) and a shorter length of hospital stay (median, 21 d [interquartile range, 18-29 d] versus 38 d [interquartile range, 28-45 d], respectively; P = 0.015 and P = 0.003 after PSM). Solid food intake after decompression and preoperative temporary discharge occurred only in the SEMS group.



Preoperative SEMS insertion for MLBO is effective with at least equivalent short-term outcomes and superior preoperative quality of life compared with decompression using TDT.
Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba, Japan. Electronic address: a-matsu@nms.ac.jp.
Akihisa
A
Matsuda
Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba, Japan.
Masao
M
Miyashita
Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba, Japan.
Satoshi
S
Matsumoto
Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba, Japan.
Nobuyuki
N
Sakurazawa
Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba, Japan.
Goro
G
Takahashi
Department of Surgery, Nippon Medical School, Tokyo, Japan.
Takeshi
T
Matsutani
Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba, Japan.
Marina
M
Yamada
Department of Surgery, Nippon Medical School, Tokyo, Japan.
Eiji
E
Uchida
D000368:Aged; D015179:Colorectal Neoplasms / Q000150:complications*; D019299:Decompression, Surgical / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D057216:Propensity Score; D012189:Retrospective Studies; D000069322:Self Expandable Metallic Stents; D000067368:Transanal Endoscopic Surgery; D016896:Treatment Outcome
Bridge to surgery; Colorectal cancer; Obstruction; Self-expandable metallic colonic stent; Transanal decompression tube