Original articleResults of a National Survey on the Use of Stents for the Treatment of Colonic ObstructionResultados de una encuesta nacional sobre el uso de stent para el tratamiento de la obstrucción de colon☆
Graphical abstract
Introduction
It is estimated that some 41,411 new cases of colon cancer are diagnosed in Spain each year, and 10%-30% begin with clinical signs of colon obstruction.1
Treatment of the obstruction differs according to the hospital in which it is treated. Decision-making is influenced by both patient characteristics—tumor location, extension of the oncological disease, age and comorbidities—as well as the characteristics of the healthcare setting—the surgeon's or gastroenterologist's preferences, caseload and availability of resources. For these reasons, different management options include: urgent surgery, decompression with colonic stent prior to preferential surgery (CS-S), and colonic stent as palliative therapy or to initiate neoadjuvant therapy (CS-P).
The objective of this study was to determine the indications for colonic stents (CS) as a treatment for obstructive colon cancer (OCC) performed in Spanish hospitals. As secondary objectives, we analyzed whether there was agreement between these indications and the recommendations of official European and American guidelines (compliance with guidelines) and whether knowing these official guidelines influenced the responses of the participants.2
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Methods
A descriptive study was conducted with data collected through an online survey sent to the members of the Spanish Association of Surgeons (Asociación Española de Cirujanos), Catalan Society of Surgery (Societat Catalana de Cirurgia) and the Spanish Society of Digestive Endoscopy (Sociedad Española de Endoscopia Digestiva). The email of each respondent was registered to avoid duplicate responses.
The survey was carried out from March to May 2017 using Google Forms (Appendix B, Annex 1). It
Statistical Analysis
The statistical analysis was carried out with the SPSS computer software from 2008, version 16.0. The descriptive analysis of the variables was carried out, including means and medians, as well as the proportions for the categorical variables of the main results.
Surveys that did not have complete epidemiological and workplace data were excluded.
Results
We received 388 surveys, 340 of which were complete. The epidemiological data of the respondents, as well as the data referring to their usual clinical situation, are summarized in Table 1. In terms of the main national societies, 4.5% of AEC members and 10.5% of SEED associates responded.
The majority of those surveyed (65%) worked in medium-sized hospitals (300–600 beds) or regional hospitals (less than 300 beds). Only 8.8% were employed at hospitals with more than 1000 beds.
When we analyzed
Clinical Cases
The responses given by the respondents to the different clinical cases with colon obstruction are summarized in Table 2.
65.2% of the respondents’ responses followed the recommendations of the official guidelines. Compliance did not change with the years of experience of the respondents.
We compared the specialists who reported knowing the guidelines versus those who did not, without observing differences in the overall number of responses according to the guideline recommendations between the 2
Discussion
Since the appearance of CS, several official guidelines have been published for the treatment of OCC,2, 3, 4, 5 which coincide in the majority of their recommendations. In other European countries like France, Sweden, Norway and the Netherlands, CS have been all but abandoned.3 Meanwhile, stents continue to be the standard treatment for many surgeons in the United Kingdom, who are themselves responsible for their placement. In Spain, the situation and compliance with guidelines had not been
Limitations of Our Study
As it is a survey, the responses provided about previous activities may be influenced by subjective perceptions of the respondent, and therefore differ from the use of CS and its actual indications due to memory bias. Similarly, there may be a certain participation bias in the survey, and those who have responded are mainly those most interested in the use of the stent, altering the representativeness of its use. These biases could be avoided through a national registry on CS use, which would
Conclusion
Colonic stents are an established therapeutic option for the treatment of colon obstruction in Spain. The vast majority of participants used it only in selected cases, and we observed heterogeneous indications and a greater tendency of its use by gastroenterologists than by surgeons.
The compliance with international guidelines reported by most participants was moderate.
A high percentage of respondents did not act in accordance with the recommendations, and we have observed a tendency to reserve
Conflict of Interests
The authors have no conflict of interests to declare.
Acknowledgements
The authors would like to thank the Asociación Española de Cirujanos, Societat Catalana de Cirurgia and the Sociedad Española de Endoscopia Digestiva for their approval and distribution of the survey, as well as all the participants for their responses.
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Please cite this article as: Alonso-Hernández N, Segura-Sampedro JJ, Soldevila Verdeguer CM, Ochogavía Seguí A, Olea Martinez-Mediero JM, Fernández Isart M, et al. Resultados de una encuesta nacional sobre el uso de stent para el tratamiento de la obstrucción de colon. Cir Esp. 2020. https://doi.org/10.1016/j.ciresp.2020.02.006