Endoscopy 2021; 53(09): 905-913
DOI: 10.1055/a-1308-1487
Original article

Time interval between self-expandable metal stent placement or creation of a decompressing stoma and elective resection of left-sided obstructive colon cancer

Joyce Valerie Veld
 1  Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
 2  Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, The Netherlands
,
Aydan Kumcu
 2  Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, The Netherlands
,
Femke Julie Amelung
 3  Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
,
Wernard Aat Antoine Borstlap
 1  Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
,
Esther Catharina Josephina Consten
 4  Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
 5  Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
,
Jan Willem Teunis Dekker
 6  Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands
,
Henderik Leendert van Westreenen
 7  Department of Surgery, Isala Zwolle, Zwolle, The Netherlands
,
Peter D. Siersema
 8  Department of Gastroenterology and Hepatology, Radboud Academic Medical Center, Nijmegen, The Netherlands
,
Frank ter Borg
 9  Department of Gastroenterology and Hepatology, Deventer Hospital, Deventer, The Netherlands
,
Miranda Kusters
10  Department of Surgery, Amsterdam UMC, Vrije Universiteit, Cancer Center Amsterdam, Amsterdam, The Netherlands
,
Wilhelmus Adrianus Bemelman
 1  Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
,
Johannes Hendrik Willem de Wilt
11  Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
,
Jeanin E. van Hooft* 
 2  Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, The Netherlands
12  Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
,
Pieter Job Tanis* 
 1  Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
,
on behalf of the Dutch Snapshot Research Group› Author Affiliations

Abstract

Background The optimal timing of resection after decompression of left-sided obstructive colon cancer is unknown. Revised expert-based guideline recommendations have shifted from an interval of 5 – 10 days to approximately 2 weeks following self-expandable metal stent (SEMS) placement, and recommendations after decompressing stoma are lacking. We aimed to evaluate the recommended bridging intervals after SEMS and explore the timing of resection after decompressing stoma.

Methods This nationwide study included patients registered between 2009 and 2016 in the prospective, mandatory Dutch ColoRectal Audit. Additional data were collected through patient records in 75 hospitals. Only patients who underwent either SEMS placement or decompressing stoma as a bridge to surgery were selected. Technical SEMS failure and unsuccessful decompression within 48 hours were exclusion criteria.

Results 510 patients were included (182 SEMS, 328 decompressing stoma). Median bridging interval was 23 days (interquartile range [IQR] 13 – 31) for SEMS and 36 days (IQR 22 – 65) for decompressing stoma. Following SEMS placement, no significant differences in post-resection complications, hospital stay, or laparoscopic resections were observed with resection after 11 – 17 days compared with 5 – 10 days. Of SEMS-related complications, 48 % occurred in patients operated on beyond 17 days. Compared with resection within 14 days, an interval of 14 – 28 days following decompressing stoma resulted in significantly more laparoscopic resections, more primary anastomoses, and shorter hospital stays. No impact of bridging interval on mortality, disease-free survival, or overall survival was demonstrated.

Conclusions Based on an overview of the data with balancing of surgical outcomes and timing of adverse events, a bridging interval of approximately 2 weeks seems appropriate after SEMS placement, while waiting 2 – 4 weeks after decompressing stoma further optimizes surgical conditions for laparoscopic resection with restoration of bowel continuity.

*  Shared senior authorship


** Collaborators in the Dutch Snapshot Research Group: H. Algera, G.D. Algie, C.S. Andeweg, T.E. Argillander, M.N.N.J. Arron, K. Arts, T.H.J. Aufenacker, I.S. Bakker, M. van Basten Batenburg, A.J.N.M. Bastiaansen, G.L. Beets, A. van den Berg, B. van de Beukel, R.L.G.M. Blom, B. Blomberg, E.G. Boerma, F.C. den Boer, N.D. Bouvy, J.E. Bouwman, N.D.A. Boye, A.R.M. Brandt-Kerkhof, H.T. Bransma, A. Breijer, W.T. van den Broek, M.E.E. Bröker, J.P.M. Burbach, E.R.J. Bruns, T.A. Burghgraef, R.M.P.H. Crolla, M. Dam, L. Daniels, A. Demirkiran, K.W. van Dongen, S.F. Durmaz, A. van Esch, J.A. van Essen, J.W. Foppen, E.J.B. Furnee, A.A.W. van Geloven, M.F. Gerhards, E.A. Gorter, W.M.U. van Grevenstein, J. van Groningen, I.A.J. de Groot-van Veen, H.E. Haak, J.W.A. de Haas, P. van Hagen, J.T.H. Hamminga, K. Havenga, B. van den Hengel, E. van der Harst, J. Heemskerk, J. Heeren, B.H.M. Heijnen, L. Heijnen, J.T. Heikens, M. van Heinsbergen, D.A. Hess, N. Heuchemer, C. Hoff, W. Hogendoorn, A.P.J. Houdijk, N. Hugen, B. Inberg, T.L. Janssen, D. Jean Pierre, W.J. de Jong, A.C.H.M. Jongen, A.V. Kamman, J.M. Klaase, W. Kelder, E.F. Kelling, R. Klicks, G.W. De Klein, F.W.H. Kloppenberg, J.L.M. Konsten, L.J.E.R. Koolen, V. Kornmann, R.T.J. Kortekaas, A. Kreiter, B. Lamme, J.F. Lange, T. Lettinga, D. Lips, G. Lo, F. Logeman, Y.T. van Loon, M.F. Lutke Holzik, C.C.M. Marres, I. Masselink, A. Mearadji, G. Meisen, A.G. Menon, J.W.S. Merkus, D.J.L.M. de Mey, H.C.J. van der Mijle, D.E. Moes, C.J.L. Molenaar, M.J. Nieboer, K. Nielsen, G.A.P. Nieuwenhuijzen, P.A. Neijenhuis, P. Oomen, N. van Oorschot, K. Parry, K.C.M.J. Peeters, T. Paulides, I. Paulusma, F.B. Poelmann, S.W. Polle, P. Poortman, M.H. Raber, R.J. Renger, B.M.M. Reiber, R. Roukema, W.M.J. de Ruijter, M.J.A.M. Russchen, H.J.T. Rutten, J. Scheerhoorn, S. Scheurs, H. Schippers, V.N.E. Schuermans, H.J. Schuijt, J.C. Sierink, C. Sietses, R. Silvis, J. van der Slegt, G.D. Slooter, M. van der Sluis, P. van der Sluis, N. Smakman, D. Smit, A.B. Smits, T.C. van Sprundel, D.J.A. Sonneveld, C. Steur, J. Straatman, M.C. Struijs, H.A. Swank, A.K. Talsma, M. Tenhagen, J.A.M.G. Tol, J.L. Tolenaar, L. Tseng, J.B. Tuynman, M.J.F. van Veen, S.C. Veltkamp, A.W.H. van de Ven, L. Verkoele, M. Vermaas, H.P. Versteegh, L. Verslijs, T. Visser, D. van Uden, W.J. Vles, R.J. de Vos tot Nederveen Cappel, H.S. de Vries, S.T. van Vugt, G. Vugts, J.A. Wegdam, T.J. Weijs, B.J. van Wely, M. Westerterp, B. Wiering, N.A.T. Wijffels, A.A. Wijkmans, L.H. Wijngaarden, M. van de Wilt, D.D. Wisselink, F. Wit, D.D.E. Zimmerman, T.L.R. Zwols.


Fig. 1s, Table 1s



Publication History

Received: 06 July 2020

Accepted: 19 October 2020

Publication Date:
18 December 2020 (online)

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