Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 28, 2019; 25(16): 1975-1985
Published online Apr 28, 2019. doi: 10.3748/wjg.v25.i16.1975
Comparison of decompression tubes with metallic stents for the management of right-sided malignant colonic obstruction
Yoshiyuki Suzuki, Konosuke Moritani, Yuki Seo, Takayuki Takahashi
Yoshiyuki Suzuki, Konosuke Moritani, Yuki Seo, Takayuki Takahashi, Department of Surgery, Ashikaga Red Cross Hospital, Tochigi 326-0843, Japan
Author contributions: Suzuki Y, Moritani K, Seo Y, and Takahashi T designed the report; Suzuki Y and Moritani K analyzed the data and wrote the paper; all authors checked the draft and approved the final version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Ashikaga Red Cross Hospital Institutional Review Board.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: There is no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yoshiyuki Suzuki, MD, Doctor, Department of Surgery, Ashikaga Red Cross Hospital, 284-1, Yobe-cho, Ashikaga-shi, Tochigi 326-0843, Japan. yopy4971@hotmail.co.jp
Telephone: +81-284-210121 Fax: +81-284-220225
Received: December 4, 2018
Peer-review started: December 6, 2018
First decision: January 11, 2019
Revised: January 25, 2019
Accepted: January 28, 2019
Article in press: January 28, 2019
Published online: April 28, 2019
Abstract
BACKGROUND

Emergency surgical resection is a standard treatment for right-sided malignant colonic obstruction; however, the procedure is associated with high rates of mortality and morbidity. Although a bridge to surgery can be created to obviate the need for emergency surgery, its effects on long-term outcomes and the most practical management strategies for right-sided malignant colonic obstruction remain unclear.

AIM

To determine the appropriate management approach for right-sided malignant colonic obstruction.

METHODS

Forty patients with right-sided malignant colonic obstruction who underwent curative resection from January 2007 to April 2017 were included in the study. We compared the perioperative and long-term outcomes of patients who received bridges to surgery established using decompression tubes and those created using self-expandable metallic stents (SEMS). The primary outcome was the overall survival duration (OS) and the secondary endpoints were the disease-free survival (DFS) duration and the preoperative and postoperative morbidity rates. Analysis was performed on an intention-to-treat basis.

RESULTS

There were 21 patients in the decompression tube group and 19 in the SEMS group. There were no significant differences in the perioperative morbidity rates of the two groups. The OS rate was significantly higher in the decompression tube group than in the SEMS group (5-year OS rate; decompression tube 79.5%, SEMS 32%, P = 0.043). Multivariate analysis revealed that the bridge to surgery using a decompression tube was significantly associated with the OS (hazard ratio, 17.41; P = 0.004). The 3-year DFS rate was significantly higher in the decompression tube group than in the SEMS group (68.9% vs 45.9%; log-rank test, P = 0.032). A propensity score–adjusted analysis also demonstrated that the prognosis was significantly better in the decompression tube group than in the SEMS group.

CONCLUSION

The bridge to surgery using trans-nasal and trans-anal decompression tubes for right-sided malignant colonic obstruction is safe and may improve long-term outcomes.

Keywords: Right-sided colon cancer, Large bowel obstruction, Self-expandable metallic stent, Trans-anal tube, Trans-nasal tube

Core tip: Patients with malignant colonic obstructions typically undergo emergency surgery, which is associated with high rates of mortality and morbidity. To overcome this, bridges to surgery have been proposed, but their efficacy in patients with right-sided malignant colonic obstructions remains unclear, mainly because obstructions are less common in patients with right- than left-sided colon cancer. We compared two bridges to surgery: Decompression tubes and self-expandable metallic stents. The short-term outcomes of the two groups did not differ, but the overall survival and disease-free survival rates were better in the former patients, suggesting that decompression tube placement may be optimal.