Deviating colostomy construction versus stent placement as bridge to surgery for malignant left-sided colonic obstruction
Background Acute colonic decompression using a deviating colostomy (DC) or a self-expandable metal stent (SEMS) has been shown to lead to fewer complications and permanent stomas compared to acute resection in elderly patients with malignant left-sided colonic obstruction (LSCO). However, no consens...
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| creator | Amelung, Femke J. ter Borg, Frank Consten, Esther C. J. Siersema, Peter D. Draaisma, Werner A. |
| description | Background
Acute colonic decompression using a deviating colostomy (DC) or a self-expandable metal stent (SEMS) has been shown to lead to fewer complications and permanent stomas compared to acute resection in elderly patients with malignant left-sided colonic obstruction (LSCO). However, no consensus exists on which decompression method is superior, especially in patients treated with curative intend. This retrospective study therefore aimed to compare both decompression methods in potentially curable LSCO patients.
Methods
All LSCO patients treated with curative intent between 2004 and 2013 in two teaching hospitals were retrospectively identified. In one institution, a DC was the standard of care, whereas in the other all patients were treated with SEMS.
Results
In total, 88 eligible LSCO patients with limited disease and curative treatment options were included; 51 patients had a SEMS placed and 37 patients a DC constructed. All patients eventually underwent a subsequent elective resection. In sum, 235 patients were excluded due to benign or inoperable disease. No significant differences were found for hospital stay, morbidity, disease-free and overall survival and mortality. Major complications were seen in 13/51 (25.5 %) patients in the SEMS group and were mostly due to stent dysfunction (
n
= 7). Also, one stent-related perforation occurred. Major complications occurred in 4/37 (10.8 %) patients in the DC group, including abdominal sepsis (
n
= 3) and wound dehiscence (
n
= 1). Long-term complication rate was significantly higher in the DC group (29.7 vs. 9.8 %,
p
= 0.01), mainly due to a high incisional hernia rate. Fewer patients had a temporary colostomy following elective resection after SEMS placement (62.2 vs. 17.6 %,
p
|
| doi_str_mv | 10.1007/s00464-016-4887-9 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1826664179</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>4252481491</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-e5c9aff39d415fb831f6507d92066ec89790cd9fbd5f157ad4f0d18bdfd6e1ed3</originalsourceid><addsrcrecordid>eNp1kU1rFTEUhoNY7G3rD3AjATduYpNMJpkspX5UKLix65DJxyVlZnLNyRTuvzfjrUUEVzmQ5zzncF6E3jD6gVGqroFSIQWhTBIxDIroF2jHRMcJ52x4iXZUd5RwpcU5ugB4oA3XrH-Fzrmiimmuduj4KTwmW9Oyxy5PGWqej61aoJbV1ZQX_BgKrIChhqXiw2RdmLfKAh5L8vuAa8awln0oRxxzwbOd0n6xDZlCrASSD_63e0kO5_FZfIXOop0gvH56L9H9l88_bm7J3fev324-3hHXKV5J6J22MXbaC9bHcehYlD1VXnMqZXCDVpo6r-Po-8h6Zb2I1LNh9NHLwILvLtH7k_dQ8s81QDVzAhemyS4hr2DYwKWUgind0Hf_oA95LUvbrlGCKtVrtlHsRLmSAUqI5lDSbMvRMGq2XMwpF9NyMVsuZut5-2Rexzn4544_QTSAnwBoX0s75l-j_2v9Bbxpm7w</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1840775919</pqid></control><display><type>article</type><title>Deviating colostomy construction versus stent placement as bridge to surgery for malignant left-sided colonic obstruction</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Amelung, Femke J. ; ter Borg, Frank ; Consten, Esther C. J. ; Siersema, Peter D. ; Draaisma, Werner A.</creator><creatorcontrib>Amelung, Femke J. ; ter Borg, Frank ; Consten, Esther C. J. ; Siersema, Peter D. ; Draaisma, Werner A.</creatorcontrib><description>Background
Acute colonic decompression using a deviating colostomy (DC) or a self-expandable metal stent (SEMS) has been shown to lead to fewer complications and permanent stomas compared to acute resection in elderly patients with malignant left-sided colonic obstruction (LSCO). However, no consensus exists on which decompression method is superior, especially in patients treated with curative intend. This retrospective study therefore aimed to compare both decompression methods in potentially curable LSCO patients.
Methods
All LSCO patients treated with curative intent between 2004 and 2013 in two teaching hospitals were retrospectively identified. In one institution, a DC was the standard of care, whereas in the other all patients were treated with SEMS.
Results
In total, 88 eligible LSCO patients with limited disease and curative treatment options were included; 51 patients had a SEMS placed and 37 patients a DC constructed. All patients eventually underwent a subsequent elective resection. In sum, 235 patients were excluded due to benign or inoperable disease. No significant differences were found for hospital stay, morbidity, disease-free and overall survival and mortality. Major complications were seen in 13/51 (25.5 %) patients in the SEMS group and were mostly due to stent dysfunction (
n
= 7). Also, one stent-related perforation occurred. Major complications occurred in 4/37 (10.8 %) patients in the DC group, including abdominal sepsis (
n
= 3) and wound dehiscence (
n
= 1). Long-term complication rate was significantly higher in the DC group (29.7 vs. 9.8 %,
p
= 0.01), mainly due to a high incisional hernia rate. Fewer patients had a temporary colostomy following elective resection after SEMS placement (62.2 vs. 17.6 %,
p
< 0.01). Permanent colostomy rate was not significantly different.
Conclusion
SEMS and DC are both effective decompression methods for curable LSCO patients with comparable short- and long-term oncological outcomes; however, more surgical procedures are performed after DC due to an increased number of temporary colostomies and incisional hernia repairs.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-016-4887-9</identifier><identifier>PMID: 27071927</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdomen ; Abdominal Surgery ; Adult ; Aged ; Aged, 80 and over ; Colonic Diseases - etiology ; Colonic Diseases - surgery ; Colorectal Neoplasms - complications ; Colostomy - methods ; Decompression, Surgical - instrumentation ; Decompression, Surgical - methods ; Female ; Follow-Up Studies ; Gastroenterology ; Gynecology ; Hepatology ; Hernias ; Humans ; Intestinal Obstruction - etiology ; Intestinal Obstruction - surgery ; Male ; Medical prognosis ; Medicine ; Medicine & Public Health ; Middle Aged ; Morbidity ; Mortality ; Ostomy ; Proctology ; Quality of life ; Retrospective Studies ; Self Expandable Metallic Stents ; Surgery ; Teaching hospitals ; Treatment Outcome</subject><ispartof>Surgical endoscopy, 2016-12, Vol.30 (12), p.5345-5355</ispartof><rights>Springer Science+Business Media New York 2016</rights><rights>Surgical Endoscopy is a copyright of Springer, 2016.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-e5c9aff39d415fb831f6507d92066ec89790cd9fbd5f157ad4f0d18bdfd6e1ed3</citedby><cites>FETCH-LOGICAL-c372t-e5c9aff39d415fb831f6507d92066ec89790cd9fbd5f157ad4f0d18bdfd6e1ed3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-016-4887-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-016-4887-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27071927$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Amelung, Femke J.</creatorcontrib><creatorcontrib>ter Borg, Frank</creatorcontrib><creatorcontrib>Consten, Esther C. J.</creatorcontrib><creatorcontrib>Siersema, Peter D.</creatorcontrib><creatorcontrib>Draaisma, Werner A.</creatorcontrib><title>Deviating colostomy construction versus stent placement as bridge to surgery for malignant left-sided colonic obstruction</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
Acute colonic decompression using a deviating colostomy (DC) or a self-expandable metal stent (SEMS) has been shown to lead to fewer complications and permanent stomas compared to acute resection in elderly patients with malignant left-sided colonic obstruction (LSCO). However, no consensus exists on which decompression method is superior, especially in patients treated with curative intend. This retrospective study therefore aimed to compare both decompression methods in potentially curable LSCO patients.
Methods
All LSCO patients treated with curative intent between 2004 and 2013 in two teaching hospitals were retrospectively identified. In one institution, a DC was the standard of care, whereas in the other all patients were treated with SEMS.
Results
In total, 88 eligible LSCO patients with limited disease and curative treatment options were included; 51 patients had a SEMS placed and 37 patients a DC constructed. All patients eventually underwent a subsequent elective resection. In sum, 235 patients were excluded due to benign or inoperable disease. No significant differences were found for hospital stay, morbidity, disease-free and overall survival and mortality. Major complications were seen in 13/51 (25.5 %) patients in the SEMS group and were mostly due to stent dysfunction (
n
= 7). Also, one stent-related perforation occurred. Major complications occurred in 4/37 (10.8 %) patients in the DC group, including abdominal sepsis (
n
= 3) and wound dehiscence (
n
= 1). Long-term complication rate was significantly higher in the DC group (29.7 vs. 9.8 %,
p
= 0.01), mainly due to a high incisional hernia rate. Fewer patients had a temporary colostomy following elective resection after SEMS placement (62.2 vs. 17.6 %,
p
< 0.01). Permanent colostomy rate was not significantly different.
Conclusion
SEMS and DC are both effective decompression methods for curable LSCO patients with comparable short- and long-term oncological outcomes; however, more surgical procedures are performed after DC due to an increased number of temporary colostomies and incisional hernia repairs.</description><subject>Abdomen</subject><subject>Abdominal Surgery</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Colonic Diseases - etiology</subject><subject>Colonic Diseases - surgery</subject><subject>Colorectal Neoplasms - complications</subject><subject>Colostomy - methods</subject><subject>Decompression, Surgical - instrumentation</subject><subject>Decompression, Surgical - methods</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Hernias</subject><subject>Humans</subject><subject>Intestinal Obstruction - etiology</subject><subject>Intestinal Obstruction - surgery</subject><subject>Male</subject><subject>Medical prognosis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Ostomy</subject><subject>Proctology</subject><subject>Quality of life</subject><subject>Retrospective Studies</subject><subject>Self Expandable Metallic Stents</subject><subject>Surgery</subject><subject>Teaching hospitals</subject><subject>Treatment Outcome</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kU1rFTEUhoNY7G3rD3AjATduYpNMJpkspX5UKLix65DJxyVlZnLNyRTuvzfjrUUEVzmQ5zzncF6E3jD6gVGqroFSIQWhTBIxDIroF2jHRMcJ52x4iXZUd5RwpcU5ugB4oA3XrH-Fzrmiimmuduj4KTwmW9Oyxy5PGWqej61aoJbV1ZQX_BgKrIChhqXiw2RdmLfKAh5L8vuAa8awln0oRxxzwbOd0n6xDZlCrASSD_63e0kO5_FZfIXOop0gvH56L9H9l88_bm7J3fev324-3hHXKV5J6J22MXbaC9bHcehYlD1VXnMqZXCDVpo6r-Po-8h6Zb2I1LNh9NHLwILvLtH7k_dQ8s81QDVzAhemyS4hr2DYwKWUgind0Hf_oA95LUvbrlGCKtVrtlHsRLmSAUqI5lDSbMvRMGq2XMwpF9NyMVsuZut5-2Rexzn4544_QTSAnwBoX0s75l-j_2v9Bbxpm7w</recordid><startdate>20161201</startdate><enddate>20161201</enddate><creator>Amelung, Femke J.</creator><creator>ter Borg, Frank</creator><creator>Consten, Esther C. J.</creator><creator>Siersema, Peter D.</creator><creator>Draaisma, Werner A.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20161201</creationdate><title>Deviating colostomy construction versus stent placement as bridge to surgery for malignant left-sided colonic obstruction</title><author>Amelung, Femke J. ; ter Borg, Frank ; Consten, Esther C. J. ; Siersema, Peter D. ; Draaisma, Werner A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-e5c9aff39d415fb831f6507d92066ec89790cd9fbd5f157ad4f0d18bdfd6e1ed3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Abdomen</topic><topic>Abdominal Surgery</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Colonic Diseases - etiology</topic><topic>Colonic Diseases - surgery</topic><topic>Colorectal Neoplasms - complications</topic><topic>Colostomy - methods</topic><topic>Decompression, Surgical - instrumentation</topic><topic>Decompression, Surgical - methods</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Hernias</topic><topic>Humans</topic><topic>Intestinal Obstruction - etiology</topic><topic>Intestinal Obstruction - surgery</topic><topic>Male</topic><topic>Medical prognosis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Ostomy</topic><topic>Proctology</topic><topic>Quality of life</topic><topic>Retrospective Studies</topic><topic>Self Expandable Metallic Stents</topic><topic>Surgery</topic><topic>Teaching hospitals</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Amelung, Femke J.</creatorcontrib><creatorcontrib>ter Borg, Frank</creatorcontrib><creatorcontrib>Consten, Esther C. J.</creatorcontrib><creatorcontrib>Siersema, Peter D.</creatorcontrib><creatorcontrib>Draaisma, Werner A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Amelung, Femke J.</au><au>ter Borg, Frank</au><au>Consten, Esther C. J.</au><au>Siersema, Peter D.</au><au>Draaisma, Werner A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Deviating colostomy construction versus stent placement as bridge to surgery for malignant left-sided colonic obstruction</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2016-12-01</date><risdate>2016</risdate><volume>30</volume><issue>12</issue><spage>5345</spage><epage>5355</epage><pages>5345-5355</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
Acute colonic decompression using a deviating colostomy (DC) or a self-expandable metal stent (SEMS) has been shown to lead to fewer complications and permanent stomas compared to acute resection in elderly patients with malignant left-sided colonic obstruction (LSCO). However, no consensus exists on which decompression method is superior, especially in patients treated with curative intend. This retrospective study therefore aimed to compare both decompression methods in potentially curable LSCO patients.
Methods
All LSCO patients treated with curative intent between 2004 and 2013 in two teaching hospitals were retrospectively identified. In one institution, a DC was the standard of care, whereas in the other all patients were treated with SEMS.
Results
In total, 88 eligible LSCO patients with limited disease and curative treatment options were included; 51 patients had a SEMS placed and 37 patients a DC constructed. All patients eventually underwent a subsequent elective resection. In sum, 235 patients were excluded due to benign or inoperable disease. No significant differences were found for hospital stay, morbidity, disease-free and overall survival and mortality. Major complications were seen in 13/51 (25.5 %) patients in the SEMS group and were mostly due to stent dysfunction (
n
= 7). Also, one stent-related perforation occurred. Major complications occurred in 4/37 (10.8 %) patients in the DC group, including abdominal sepsis (
n
= 3) and wound dehiscence (
n
= 1). Long-term complication rate was significantly higher in the DC group (29.7 vs. 9.8 %,
p
= 0.01), mainly due to a high incisional hernia rate. Fewer patients had a temporary colostomy following elective resection after SEMS placement (62.2 vs. 17.6 %,
p
< 0.01). Permanent colostomy rate was not significantly different.
Conclusion
SEMS and DC are both effective decompression methods for curable LSCO patients with comparable short- and long-term oncological outcomes; however, more surgical procedures are performed after DC due to an increased number of temporary colostomies and incisional hernia repairs.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>27071927</pmid><doi>10.1007/s00464-016-4887-9</doi><tpages>11</tpages></addata></record> |
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| subjects | Abdomen Abdominal Surgery Adult Aged Aged, 80 and over Colonic Diseases - etiology Colonic Diseases - surgery Colorectal Neoplasms - complications Colostomy - methods Decompression, Surgical - instrumentation Decompression, Surgical - methods Female Follow-Up Studies Gastroenterology Gynecology Hepatology Hernias Humans Intestinal Obstruction - etiology Intestinal Obstruction - surgery Male Medical prognosis Medicine Medicine & Public Health Middle Aged Morbidity Mortality Ostomy Proctology Quality of life Retrospective Studies Self Expandable Metallic Stents Surgery Teaching hospitals Treatment Outcome |
| title | Deviating colostomy construction versus stent placement as bridge to surgery for malignant left-sided colonic obstruction |
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