Evaluación de la recurrencia local y supervivencia a largo plazo en enfermos de cáncer de colon izquierdo obstructivoendoprótesis puente a cirugía programada versus cirugía urgente

Abstract

Background: Colonic stent as a bridge to elective surgery for left-sided malignant colonic obstruction is an alternative to emergency surgery, having shown an improvement in short-term results by improving the number of primary anastomoses and aby decreasing the number of stoma with a comparable morbi-mortality. However, the long-term results offered by this kind of treatment have been questioned, in terms of overall survival and recurrence. The aim of our study was to evaluate recurrence and long-term survival in patients with obstructive left colon cancer treated with colonic stent and elective surgery versus emergency surgery. Materials and Methods: A retrospective cohort study, where all the patients with left-sided malignant colonic obstruction admitted in the Emergency Department of Ramón y Cajal University Hospital between june 2006 and january 2014 have been consecutively included. They were treated either with colonic stent as a brigde to elective surgery or with emergency surgery in a single time (stent group versus surgery group). The observation period was from june 2006 until september 2018. The main study variables were overall survival, local recurrence and distance recurrence. As secondary objectives were the number of primary anastomoses, the number of stomas, the morbidity and mortality associated with each technique and the lenght of hospital stay, were also studied. Results: 53 patients were treated with colonic stent as a brigde to elective surgery and 40 patients were treated with emergency surgery. Local recurrence was only presented in 2 patients of the surgery group with a mean of 17.6 months ± 2.7. Distance recurrence was more frequent in the surgery group (34.2% versus 17.8%), although without significant differences, multiplying the risk of recurrence by 2.22 times in the surgery group (SHR 2.22 CI 95 % 0.92-5.30 p 0.07). Overall survival (OS) did not show significant differences between the treatment groups, being lower in the stent group (5- year OS at 60.4% in the stent group versus 68.5% in the surgery group). Regarding the secondary objectives, significant differences were found in terms of the highest rate of primary anastomosis in the stent group (75% versus 52.5% p 0.02) and a lower proportion of stoma (27% versus 47.5% p 0.04). Postoperative morbidity and mortality, although they did not show significant differences, were greater in the stent group. The lenght hospital stay also showed no significant differences, 13 days IQR (11-19) for the stent group versus 11 days IQR (14.5-17.5) for the surgery group (p 0.95). Conclusions: The long-term results showed no significant differences between the two groups. However, there was a significant improvement in the short-term results in the sten group, in terms of the rate of primary anastomosis and stoma, as already shown in previous studies.