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Colonic stenting as a bridge to surgery versus emergency surgery for malignant colonic obstruction: results of a multicentre randomised controlled trial (ESCO trial).
- Source :
-
Surgical Endoscopy & Other Interventional Techniques . Aug2017, Vol. 31 Issue 8, p3297-3305. 9p. 7 Charts, 2 Graphs. - Publication Year :
- 2017
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Abstract
- <bold>Background: </bold>The aim of colonic stenting with self-expandable metallic stents in neoplastic colon obstruction is to avoid emergency surgery and thus potentially reduce morbidity, mortality, and need for a stoma. Concern has been raised, however, about the effect of colonic stenting on short-term complications and long-term survival. We compared morbidity rates after colonic stenting as a bridge to surgery (SBTS) versus emergency surgery (ES) in the management of left-sided malignant large-bowel obstruction.<bold>Methods: </bold>This multicentre randomised controlled trial was designed with the endorsement of the European Association for Endoscopic Surgery. The study population was consecutive patients with acute, symptomatic malignant left-sided large-bowel obstruction localised between the splenic flexure and 15 cm from the anal margin. The primary outcome was overall morbidity within 60 days after surgery.<bold>Results: </bold>Between March 2008 and November 2015, 144 patients were randomly assigned to undergo either SBTS or ES; 29/144 (13.9%) were excluded post-randomisation mainly because of wrong diagnosis at computed tomography examination. The remaining 115 patients (SBTS n = 56, ES n = 59) were deemed eligible for analysis. The complications rate within 60 days was 51.8% in the SBTS group and 57.6% in the ES group (p = 0.529). Although long-term follow-up is still ongoing, no statistically significant difference in 3-year overall survival (p = 0.998) and progression-free survival rates between the groups has been observed (p = 0.893). Eleven patients in the SBTS group and 23 in the ES group received a stoma (p = 0.031), with a reversal rate of 30% so far.<bold>Conclusions: </bold>Our findings indicate that the two treatment strategies are equivalent. No difference in oncologic outcome was found at a median follow-up of 36 months. The significantly lower stoma rate noted in the SBTS group argues in favour of the SBTS procedure when performed in expert hands. [ABSTRACT FROM AUTHOR]
- Subjects :
- *SURGICAL stents
*SURGICAL emergencies
*RANDOMIZED controlled trials
*BOWEL obstructions
*ENDOSCOPIC surgery
*THERAPEUTICS
*COLON surgery
*COLON tumors
*COMPARATIVE studies
*RESEARCH methodology
*MEDICAL cooperation
*MEDICAL emergencies
*PROGNOSIS
*RESEARCH
*EVALUATION research
*ACUTE diseases
*DISEASE complications
Subjects
Details
- Language :
- English
- ISSN :
- 18666817
- Volume :
- 31
- Issue :
- 8
- Database :
- Academic Search Index
- Journal :
- Surgical Endoscopy & Other Interventional Techniques
- Publication Type :
- Academic Journal
- Accession number :
- 123992617
- Full Text :
- https://doi.org/10.1007/s00464-016-5362-3