Surgical failure after colonic stenting as a bridge to surgery

Table 1 Baseline demographic and clinical characteristics of patients n (%)

	Total (n = 68)
Age (yr)	64.9 (38-89)
Male/female	48 (70.6)/20 (29.4)
BMI (kg/m2)	22.9 (17.7-31.9)
Previous IA surgery	19 (27.9)
Laboratory findings
Hemoglobin (g/dL)	12.4 (7.2-17.3)
White blood cells (/mm3)	8471.7 (3050-19850)
Albumin (g/dL)	3.8 (2.5-5.2)
ASA classification
1	11 (16.2)
2	50 (73.5)
3	7 (10.3)
TNM Stage of tumor
II	22 (32.4)
III	26 (38.2)
IVA	20 (29.4)
Histology
WD	8 (11.8)
MD	57 (83.8)
PD	3 (5.6)
Location of obstruction
Sigmoid flexure	5 (7.4)
Descending colon	7 (10.3)
Sigmoid-descending area	9 (13.2)
Sigmoid colon	22 (32.4)
Recto-sigmoid area	25 (36.8)

BMI: Body mass index; IA: Intra-abdominal; ASA: American society of anesthesiologists; WD: Well-differentiated cancer; MD: Moderate-differentiated cancer; PD: Poorly-differentiated cancer.

Table 2 Etiology of surgical failure in patients undergoing stenting as a bridge to surgery n (%)

	Emergency surgery (n = 8)		Elective surgery (n = 60)		Total (n = 68)
	PTRPA(-) (n = 5)	PTRPA(+) (n = 3)	PTRPA(-) (n = 5)	PTRPA(+) (n = 55)
Surgical failure
Technical failure	1	1	0	0	2 (2.9)
Stent-related complications
Perforation	1	1	0	0	2 (2.9)
Re-obstruction	11	0	0	112	2 (2.9)
Insufficient decompression	2	1	21	0	5 (7.4)
Unsatisfactory surgical results
PTRPA not feasible	0	0	3	0	3 (4.4)
Subtotal colectomy	0	0	0	1	1 (1.5)
Surgical success
Stent-related complications
Insufficient decompression	0	0	0	11	1 (1.5)
Migration	0	0	0	2	2 (2.9)
Satisfactory surgical results				50	50 (73.5)

¹Multiple SEMS was defined as a number of stent ≥ 2 at the first session or a session number ≥ 2;

²Patients undergoing subtotal colectomy. PTRPA: Primary tumor resection and primary anastomosis.

Table 3 Types of and complications due to operations after colonic stenting as a bridge to surgery n (%)

Complications	Value
Type of operation (n = 68)
Anterior resection	27 (39.7)
Left hemicolectomy	13 (19.1)
Low anterior resection	12 (17.6)
Hartmann’s operation	7 (10.3)
Subtotal colectomy	3 (4.4)
Stoma creation	1 (1.5)
Quadrantectomy	1 (1.5)
Anterior resection with ileostomy	1 (1.5)
Total colectomy	1 (1.5)
Low anterior resection with ileostomy	1 (1.5)
Segmental resection en bloc	1 (1.5)
Surgery-related complications (n = 68)
Wound infection	1 (1.5)
Pneumonia	1 (1.5)
Anastomosis leakage	1 (1.5)

Table 4 Comparison of factors related to surgical failure and success in patients achieving technical success n (%)

	Surgical failure(n = 13)	Surgical success(n = 53)	P value
Patient-related factor
Age > 70 yr	6 (46.2)	20 (37.7)	0.578
Male	10 (76.9)	36 (67.9)	0.727
BMI < 18.5 kg/m2	3 (23.1)	1 (1.9)	0.004
Previous IA surgery	3 (23.1)	16 (30.2)	0.612
Anemia	9 (69.2)	28 (52.8)	0.286
Leukocytosis	2 (15.4)	14 (26.4)	0.406
Hypoalbuminemia	6 (46.2)	11 (20.8)	0.061
ASA 1-2	12 (92.3)	47 (88.7)	0.703
Tumor-related factor
WD and MD cancer	13 (100)	50 (94.3)	0.380
TNM stage III-IVA	12 (92.3)	32 (60.4)	0.029
Obstructive site			0.511
Sigmoid flexure	0 (0)	5 (9.4)
Descending colon	0 (0)	6 (11.3)
Sigmoid-descending area	2 (15.4)	7 (13.2)
Sigmoid colon	5 (38.5)	17 (32.1)
Recto-sigmoid colon	6 (46.2)	18 (34.0)
Flexure area	8 (61.5)	30 (56.6)	0.747
Stent-related factor
Uncovered	6 (46.2)	27 (50.9)	0.757
Diameter ≤ 22 (mm)	9 (62.5)	34 (64.2)	0.731
Length ≥ 10 (cm)	8 (61.5)	27 (50.9)	0.493
Multiple SEMS	4 (30.8)	1 (1.9)	< 0.001
Interval from SEMS to surgery (d)	9.8 (0-26)	12.1 (4-26)	0.354
Hospital stay after surgery (d)	15.4 (7-44)	11.7 (6-55)	0.151

BMI: Body mass index; IA: Intra-abdominal; ASA: American society of anesthesiologists; WD: Well-differentiated cancer; MD: Moderate-differentiated cancer; SEMS: Self-expanding metal stents.

Table 5 Multivariate analysis of risk factors for surgical failure in patients achieving technical success

	OR	95%CI	P value
BMI
≥ 18.5	1 (reference)
< 18.5	9.759	0.784-121.527	0.077
TNM stage
II	1 (reference)
III and IVA	7.685	0.666-88.722	0.102
Multiple SEMS
No	1 (reference)
Yes	28.872	1.939-429.956	0.015

BMI: Body mass index; SEMS: Self-expanding metal stents.