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KMID : 0338420230380020186
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The Korean Journal of Internal Medicine
2023 Volume.38 No. 2 p.186 ~ p.194
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Outcomes according to treatment modalities as a bridge to curative surgery for malignant obstruction of the proximal colon: stent versus stoma
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Park Yong-Eun
Hong Seung-Min
Lee Seung-Bum
Lee Hong-Sub
Baek Dong-Hoon
Cha Ra-Ri
Lee Jong-Yoon
Kim Tae-Oh
Lee Jong-Hoon
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Abstract
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Background/Aims: The optimal treatment for acute malignant obstruction of the proximal colon (MOPC, proximal to the splenic flexure) remains challenging. Emergency resection, the traditional modality for MOPC, has shown significantly high mortality and morbidity rates, according to recent studies. This study aimed to investigate the clinical outcomes of stent vs stoma as a bridge to curative surgery for MOPC.
Methods: This retrospective cohort study included 72 patients who underwent endoscopic placement of a self-expanding metallic stent (SEMS) or loop ileostomy for MOPC at six referral centers between January 2011 and July 2021. Clinical and pathological characteristics, procedure-related complications, and long-term mortality rates after curative surgery were analyzed.
Results: During a mean follow-up period of 32 months, 30 patients (41.7%) underwent ileostomy preferentially for more proximal cancer, complete obstruction, and advanced tumor stage compared to the SEMS group. No difference was found in procedure-related complications, but five deaths were observed after ileostomy. Survival analysis for 5-year mortality after curative surgery showed no significant difference between the bridge modalities (log-rank p = 0.253).
Conclusions: In this study, SEMS as a bridge to surgery showed relatively safe results in terms of post-procedural
mortality. However, these results should be considered when performing ileostomy in patients with more advanced malignant obstruction.
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KEYWORD
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Intestinal obstruction, Stents, Ileostomy
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