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Optimal interval from placement of a self-expandable metallic stent to surgery in patients with malignant large bowel obstruction

Akihisa Matsuda, MD, Satoshi Matsumoto, MD, Nobuyuki Sakurazawa, MD, Youichi Kawano, MD, Kumiko Sekiguchi, MD, Masao Miyashita, MD, Eiji Uchida, MD. Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital

Objectives: The short-term safety and efficacy of a self-expandable metallic stent (SEMS) placement followed by elective surgery, “bridge to surgery (BTS)”, for malignant large-bowel obstruction (MLBO) have been well described. The aim of this study was to investigate the risk factors for postoperative complications and optimal interval between SEMS placement and surgery in patients with MLBO.

Methods: Retrospective examination of patient records revealed that the BTS strategy was attempted in 49 patients with MLBO from January 2013 to March 2017 in our institution. Two of these patients were excluded because they had undergone emergency surgery for SEMS migration; thus, 47 patients with MLBO who had undergone SEMS placement followed by elective surgery were included. Of these patients, eight had developed postoperative complications (Clavien–Dindo grading ≥ II) (postoperative complication: POC group) whereas 39 patients had no such complications (No POC group).

Results: Univariate analyses showed that the factors of ASA score, number of lymph nodes resected, interval between SEMS and surgery, and preoperative albumin concentration were associated with postoperative complications. Multivariate analysis identified only the interval between SEMS and surgery as an independent risk factor. Furthermore, a cut-off value of 15 days for interval between SEMS and surgery was identified by ROC curve analysis.

Conclusions: An interval of ≥ 15 days from SEMS placement to surgery is an independent predictive factor for postoperative complications in patients undergoing elective surgery in a BTS setting. Thus, an interval of over 15 days is recommended for minimizing postoperative complications.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 88145

Program Number: P217

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

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