Self-expanding metallic stent as a bridge to surgery in the treatment of left colon cancer obstruction: Cost-benefit analysis and oncologic results.
BACKGROUND
The use of a self-expanding metallic stent as a bridge to surgery in acute malignant left colonic obstruction has been suggested as an alternative treatment to emergency surgery. The aim of the present study was to compare the morbi-mortality, cost-benefit and long-term oncological outcomes of both therapeutic options.


METHODS
This is a prospective, comparative, controlled, non-randomized study (2005-2010) performed in a specialized unit. The study included 82 patients with left colon cancer obstruction treated by stent as a bridge to surgery (n=27) or emergency surgery (n=55) operated with local curative intention. The main outcome measures (postoperative morbi-mortaliy, cost-benefit, stoma rate and long-term oncological outcomes) were compared based on an "intention-to-treat" analysis.


RESULTS
There were no significant statistical differences between the two groups in terms of preoperative data and tumor characteristics. The technically successful stenting rate was 88.9% (11.1% perforation during stent placement) and clinical success was 81.4%. No difference was observed in postoperative morbi-mortality rates. The primary anastomosis rate was higher in the bridge to surgery group compared to the emergency surgery group (77.8% vs. 56.4%; P=.05). The mean costs in the emergency surgery group resulted to be €1,391.9 more expensive per patient than in the bridge to surgery group. There was no significant statistical difference in oncological long-term outcomes.


CONCLUSIONS
The use of self-expanding metalllic stents as a bridge to surgery is a safe option in the urgent treatment of obstructive left colon cancer, with similar short and long-term results compared to direct surgery, inferior mean costs and a higher rate of primary anastomosis.
Departamento de Cirugía General y Digestiva, Unidad de Coloproctología, Hospital Universitario y Politécnico La Fe, Valencia, España.
Blas
B
Flor-Lorente
Departamento de Cirugía General y Digestiva, Unidad de Coloproctología, Hospital Universitario y Politécnico La Fe, Valencia, España.
Gloria
G
Báguena
Departamento de Cirugía General y Digestiva, Unidad de Coloproctología, Hospital Universitario y Politécnico La Fe, Valencia, España. Electronic address: dr.frasson.matteo@gmail.com.
Matteo
M
Frasson
Departamento de Cirugía General y Digestiva, Unidad de Coloproctología, Hospital Universitario y Politécnico La Fe, Valencia, España.
Alvaro
A
García-Granero
Departamento de Oncología, Hospital Clínico Universitario, Valencia, España.
Andrés
A
Cervantes
Departamento de Endoscopia, Hospital Clínico Universitario, Valencia, España.
Vicente
V
Sanchiz
Departamento de Endoscopia, Hospital Clínico Universitario, Valencia, España.
Andres
A
Peña
Departamento de Cirugía General y Digestiva, Unidad de Coloproctología, Hospital Clínico Universitario, Valencia, España.
Alejandro
A
Espí
Departamento de Cirugía General y Digestiva, Unidad de Coloproctología, Hospital Universitario y Politécnico La Fe, Valencia, España.
Pedro
P
Esclapez
Departamento de Cirugía General y Digestiva, Unidad de Coloproctología, Hospital Universitario y Politécnico La Fe, Valencia, España.
Eduardo
E
García-Granero
D000368:Aged; D003110:Colonic Neoplasms / Q000150:complications / Q000601:surgery*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000191:economics* / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000069322:Self Expandable Metallic Stents / Q000191:economics*; D016896:Treatment Outcome
Bridge to surgery; Cirugía de urgencia; Colon cancer; Colonic obstruction; Colonic stenting; Cost-benefit; Coste-beneficio; Cáncer de colon; Estomas evitados; Obstrucción intestinal; Recidiva; Recurrence; Self-expandable metallic stent; Stent como puente a la cirugía; Stent metálico autoexpandible; Stomas avoided; Supervivencia; Survival