Resumen de Evaluación de la recurrencia local y supervivencia a largo plazo en enfermos de cáncer de colon izquierdo obstructivo: endoprótesis puente a cirugía programada versus cirugía urgente
- español
Introducción: La endoprótesis como puente a cirugía electiva en pacientes con cáncer de colon izquierdo obstructivo es una alternativa al tratamiento quirúrgico urgente.
El objetivo del estudio es evaluar la recurrencia y la supervivencia a largo plazo en estos pacientes.
Material y Métodos: Estudio retrospectivo de cohortes, donde se incluyeron los pacientes que acudieron a Urgencias, con un cuadro clínico de obstrucción intestinal por cáncer de colon izquierdo entre junio de 2006 y enero del 2014. Se trataron mediante endoprótesis puente a cirugía electiva o mediante cirugía urgente. El período de observación fue hasta septiembre del 2018. Las variables principales fueron supervivencia global, recidiva local y recidiva a distancia. Como objetivos secundarios, se estudiaron número de anastomosis primarias y de estomas, morbi-mortalidad asociada y estancia hospitalaria.
Resultados: Fueron 53 pacientes los que pertenecieron al grupo endoprótesis y 40 pacientes al grupo cirugía. La recurrencia local sólo estuvo presente en 2 pacientes del grupo cirugía con una media de aparición 17,6 meses ± 2,7. La recidiva a distancia fue más frecuente en el grupo cirugía (34,2% versus 17,8%), aunque sin diferencias significativas. La supervivencia global (SG) no mostró diferencias significativas entre los grupos de tratamiento, siendo menor en el grupo endoprótesis (SG a los 5 años 60,4% versus 68,5%).
Sin embargo, se encontraron diferencias significativas en mayor porcentaje de anastomosis primaria en el grupo endoprótesis (75% versus 52,5% p 0,02) y una menor proporción de estomas (27% versus 47,5% p 0,04). Las complicaciones postoperatorias y la mortalidad postoperatoria, aunque no mostraron diferencias significativas, fueron mayores en el grupo endoprótesis. La estancia hospitalaria tampoco mostró diferencias significativas.
Conclusiones: Los resultados a largo plazo no mostraron diferencias significativas entre los dos grupos. Sin embargo, se observó una mejoría en la proporción de anastomosis primarias y estomas en el grupo endoprótesis de manera significativa
- English
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.
