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Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Copyright © 2023 The Korean Society of Coloproctology
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
CONFLICT OF INTEREST
No potential conflict of interest relevant to this article was reported.
FUNDING
None.
Characteristic | SEMS group | Emergency surgery group | P-value |
---|---|---|---|
No. of participants | 49 | 77 | |
Age (yr) | 68 ± 11.5 | 61 ± 14.3 | 0.006* |
Sex | 0.999 | ||
Male | 32 (65.3) | 49 (63.6) | |
Female | 17 (34.7) | 28 (36.4) | |
ASA PS classification | 0.160 | ||
I | 20 (40.8) | 38 (49.4) | |
II | 18 (36.7) | 29 (37.7) | |
III | 8 (16.3) | 10 (13.0) | |
IV | 3 (6.1) | 0 (0) | |
TNM stage | 0.327 | ||
I | 0 (0) | 0 (0) | |
II | 12 (24.5) | 28 (36.4) | |
III | 21 (42.9) | 31 (40.2) | |
IV | 16 (32.6) | 18 (23.4) | |
Lymphovascular invasion | 26 (53.1) | 39 (50.6) | 0.792 |
Perineural invasion | 13 (26.5) | 13 (16.9) | 0.192 |
Tumor location | 0.092 | ||
Splenic flexure | 0 (0) | 7 (9.1) | |
Descending colon | 8 (16.3) | 8 (10.4) | |
Sigmoid colon | 21 (42.9) | 26 (33.8) | |
Rectosigmoid colon | 20 (40.8) | 36 (46.8) | |
Follow-up (mo) | 57 ± 39.6 | 67 ± 44.6 | 0.225 |
Chemotherapy | 35/49 (71.4) | 48/77 (62.3) | 0.196 |
Chemotherapy regimen | 0.025* | ||
5-Fluorouracil-based | 20 (57.1) | 40 (83.3) | |
Oxaliplatin-based | 13 (37.1) | 8 (16.7) | |
Antiangiogenic drug | 2 (5.8) | 0 (0) | |
Radical metastasectomy at 1 year for stage IV disease | 9/16 (56.3) | 14/18 (77.8) | 0.274 |
Variable | SEMS group (n = 49) | Emergency surgery group (n = 77) | P-value |
---|---|---|---|
Technical success rate | 49 (100) | NA | |
Clinical success rate | 47 (95.9) | NA | |
Time to surgery (day) | 15 (8–29) | NA | |
Type of surgery | < 0.001* | ||
Open | 24 (49.0) | 70 (90.9) | |
Laparoscopic | 25 (51.0) | 7 (9.1) | |
Primary anastomosis without stoma | 35 (71.4) | 40 (51.9) | 0.030* |
Stoma | |||
Temporary | 10 (20.4) | 18 (23.4) | 0.696 |
Permanent | 4 (8.2) | 19 (24.7) | 0.019* |
Stent complication | |||
Perforation | 1 (2) | NA | |
Migration | 1 (2) | NA | |
Overall postoperative complication rate | 14 (28.6) | 34 (44.2) | 0.079 |
Surgical complication (Clavien-Dindo classification) | |||
Grade I | 7 | 17 | 0.659 |
Grade II | 1 | 7 | 0.149 |
Grade IIIa | 0 | 4 | 0.156 |
Grade IIIb | 3 | 5 | 0.999 |
Grade IVa | 1 | 1 | 0.628 |
Type of surgical complication | |||
Anastomotic leakage | 3 (6.1) | 3 (3.9) | |
Surgical site infection | 5 (10.2) | 13 (16.9) | |
Small bowel obstruction | 2 (4.1) | 1 (1.3) | |
Ileus | 1 (2.0) | 5 (6.5) | |
Ureteric injury | 1 (2.0) | 1 (1.3) | |
Pancreatic fistula | 0 (0) | 1 (1.3) | |
Intraabdominal bleeding | 0 (0) | 2 (2.6) | |
Fluid collection | 0 (0) | 5 (6.5) | |
Chyle leakage | 1 (2.0) | 1 (1.3) | |
Central line-associated infection | 1 (2.0) | 0 (0) | |
Myocardial infarction | 1 (2.0) | 0 (0) | |
Stroke | 0 (0) | 1 (1.3) | |
Pneumonia | 0 (0) | 2 (2.6) | |
Lung atelectasis | 0 (0) | 1 (1.3) | |
Urinary tract infection | 0 (0) | 1 (1.3) | |
Acute urinary retention | 0 (0) | 3 (3.9) | |
Postoperative duration of hospitalization (day) | 8 (6–15) | 13 (9–22) | 0.011* |
Variable |
Univariate analysis |
Multivariate analysis |
||
---|---|---|---|---|
HR (95% CI) | P-value | HR (95% CI) | P-value | |
Age, ≥ 65 yr vs. < 65 yr | 1.973 (1.230–3.165) | 0.005* | 1.709 (1.007–2.900) | 0.047* |
ASA PS classification, ≥ III vs. < III | 1.518 (0.881–2.616) | 0.133 | 1.210 (0.660–2.220) | 0.538 |
AJCC stage, ≥ III vs. < III | 2.051 (1.176–3.579) | 0.007* | 1.988 (1.038–3.809) | 0.038* |
Synchronous metastasis, yes vs. no | 2.032 (1.240–3.329) | 0.005* | 2.146 (1.191–3.866) | 0.011* |
Adjuvant chemotherapy, yes vs. no | 0.634 (0.395–1.017) | 0.059 | 0.536 (0.314–0.914) | 0.022* |
Surgical technique, MIS vs. open | 1.498 (0.913–2.456) | 0.110 | 1.483 (0.805–2.733) | 0.206 |
Type of surgery, SEMS vs. ES | 1.521 (0.959–2.412) | 0.075 | 1.233 (0.701–2.170) | 0.467 |
Characteristic | SEMS group | Emergency surgery group | P-value |
---|---|---|---|
No. of participants | 49 | 77 | |
Age (yr) | 68 ± 11.5 | 61 ± 14.3 | 0.006 |
Sex | 0.999 | ||
Male | 32 (65.3) | 49 (63.6) | |
Female | 17 (34.7) | 28 (36.4) | |
ASA PS classification | 0.160 | ||
I | 20 (40.8) | 38 (49.4) | |
II | 18 (36.7) | 29 (37.7) | |
III | 8 (16.3) | 10 (13.0) | |
IV | 3 (6.1) | 0 (0) | |
TNM stage | 0.327 | ||
I | 0 (0) | 0 (0) | |
II | 12 (24.5) | 28 (36.4) | |
III | 21 (42.9) | 31 (40.2) | |
IV | 16 (32.6) | 18 (23.4) | |
Lymphovascular invasion | 26 (53.1) | 39 (50.6) | 0.792 |
Perineural invasion | 13 (26.5) | 13 (16.9) | 0.192 |
Tumor location | 0.092 | ||
Splenic flexure | 0 (0) | 7 (9.1) | |
Descending colon | 8 (16.3) | 8 (10.4) | |
Sigmoid colon | 21 (42.9) | 26 (33.8) | |
Rectosigmoid colon | 20 (40.8) | 36 (46.8) | |
Follow-up (mo) | 57 ± 39.6 | 67 ± 44.6 | 0.225 |
Chemotherapy | 35/49 (71.4) | 48/77 (62.3) | 0.196 |
Chemotherapy regimen | 0.025 |
||
5-Fluorouracil-based | 20 (57.1) | 40 (83.3) | |
Oxaliplatin-based | 13 (37.1) | 8 (16.7) | |
Antiangiogenic drug | 2 (5.8) | 0 (0) | |
Radical metastasectomy at 1 year for stage IV disease | 9/16 (56.3) | 14/18 (77.8) | 0.274 |
Variable | SEMS group | Emergency surgery group | P-value |
---|---|---|---|
Data of overall population | 49 | 77 | |
5-Year overall survival (%) | 45 | 57 | 0.071 |
Recurrence | 20 (40.8) | 28 (36.4) | 0.707 |
Time to recurrence (mo) | 10 (5–23) | 16 (8–31) | 0.210 |
Locoregional recurrence | 1 | 5 | 0.403 |
Distant recurrence | |||
Liver | 10 | 12 | 0.352 |
Lung | 8 | 8 | 0.412 |
Peritoneum | 7 | 7 | 0.395 |
Other | 0 | 4 | 0.156 |
Data of patients without metastases at the time of diagnosis | 33 | 59 | |
5-Year overall survival (%) | 58 | 63 | 0.305 |
5-Year disease-free survival (%) | 55 | 49 | 0.768 |
Recurrence | 10 (30.3) | 20 (33.9) | 0.819 |
Time to recurrence (mo) | 11 (2–50) | 17 (1–58) | 0.340 |
Locoregional recurrence | 0 | 5 | 0.156 |
Distant recurrence | |||
Liver | 3 | 8 | 0.740 |
Lung | 6 | 7 | 0.534 |
Peritoneum | 5 | 2 | 0.093 |
Other | 0 | 3 | 0.293 |
Variable | SEMS group (n = 49) | Emergency surgery group (n = 77) | P-value |
---|---|---|---|
Technical success rate | 49 (100) | NA | |
Clinical success rate | 47 (95.9) | NA | |
Time to surgery (day) | 15 (8–29) | NA | |
Type of surgery | < 0.001 |
||
Open | 24 (49.0) | 70 (90.9) | |
Laparoscopic | 25 (51.0) | 7 (9.1) | |
Primary anastomosis without stoma | 35 (71.4) | 40 (51.9) | 0.030 |
Stoma | |||
Temporary | 10 (20.4) | 18 (23.4) | 0.696 |
Permanent | 4 (8.2) | 19 (24.7) | 0.019 |
Stent complication | |||
Perforation | 1 (2) | NA | |
Migration | 1 (2) | NA | |
Overall postoperative complication rate | 14 (28.6) | 34 (44.2) | 0.079 |
Surgical complication (Clavien-Dindo classification) | |||
Grade I | 7 | 17 | 0.659 |
Grade II | 1 | 7 | 0.149 |
Grade IIIa | 0 | 4 | 0.156 |
Grade IIIb | 3 | 5 | 0.999 |
Grade IVa | 1 | 1 | 0.628 |
Type of surgical complication | |||
Anastomotic leakage | 3 (6.1) | 3 (3.9) | |
Surgical site infection | 5 (10.2) | 13 (16.9) | |
Small bowel obstruction | 2 (4.1) | 1 (1.3) | |
Ileus | 1 (2.0) | 5 (6.5) | |
Ureteric injury | 1 (2.0) | 1 (1.3) | |
Pancreatic fistula | 0 (0) | 1 (1.3) | |
Intraabdominal bleeding | 0 (0) | 2 (2.6) | |
Fluid collection | 0 (0) | 5 (6.5) | |
Chyle leakage | 1 (2.0) | 1 (1.3) | |
Central line-associated infection | 1 (2.0) | 0 (0) | |
Myocardial infarction | 1 (2.0) | 0 (0) | |
Stroke | 0 (0) | 1 (1.3) | |
Pneumonia | 0 (0) | 2 (2.6) | |
Lung atelectasis | 0 (0) | 1 (1.3) | |
Urinary tract infection | 0 (0) | 1 (1.3) | |
Acute urinary retention | 0 (0) | 3 (3.9) | |
Postoperative duration of hospitalization (day) | 8 (6–15) | 13 (9–22) | 0.011 |
Variable | Univariate analysis |
Multivariate analysis |
||
---|---|---|---|---|
HR (95% CI) | P-value | HR (95% CI) | P-value | |
Age, ≥ 65 yr vs. < 65 yr | 1.973 (1.230–3.165) | 0.005 |
1.709 (1.007–2.900) | 0.047 |
ASA PS classification, ≥ III vs. < III | 1.518 (0.881–2.616) | 0.133 | 1.210 (0.660–2.220) | 0.538 |
AJCC stage, ≥ III vs. < III | 2.051 (1.176–3.579) | 0.007 |
1.988 (1.038–3.809) | 0.038 |
Synchronous metastasis, yes vs. no | 2.032 (1.240–3.329) | 0.005 |
2.146 (1.191–3.866) | 0.011 |
Adjuvant chemotherapy, yes vs. no | 0.634 (0.395–1.017) | 0.059 | 0.536 (0.314–0.914) | 0.022 |
Surgical technique, MIS vs. open | 1.498 (0.913–2.456) | 0.110 | 1.483 (0.805–2.733) | 0.206 |
Type of surgery, SEMS vs. ES | 1.521 (0.959–2.412) | 0.075 | 1.233 (0.701–2.170) | 0.467 |
Values are presented as number only, mean±standard deviation, or number (%). SEMS, self-expandable metal stent; ASA, American Society of Anesthesiologists; PS, physical status. P<0.05.
Values are presented as number, percentage, number (%), or median (interquartile range). SEMS, self-expandable metal stent.
Values are presented as number (%), median (interquartile range), or mean±standard deviation. SEMS, self-expandable metal stent; NA, not applicable. P<0.05.
HR, hazard ratio; CI, confidence interval; ASA, American Society of Anesthesiologists; PS, physical status; AJCC, American Joint Committee on Cancer; MIS, minimally invasive surgery; SEMS, self-expandable metal stent; ES, emergency surgery. P<0.05.