Bridge to Surgery Using a Self-Expandable Metallic Stent for Stages II–III Obstructive Colorectal Cancer

Abstract

Background: Bridge to surgery (BTS) using a self-expandable metallic stent (SEMS) for the treatment of obstructive colorectal cancer improves the patient’s quality of life. This study aimed to examine prognostic factors of obstructive colorectal cancer. Methods: We analyzed stage II-III resectable colon cancer cases (Cur A) retrospectively registered between January 2005 and 2017. We encountered Cur A cases after BTS with SEMS placement (BTS group). We compared surgical results and prognoses between the two groups. Results: A total of 50 patients underwent endoscopic SEMS placement, which technical success of 96% and morbidity rate of 18%. Overall, 117 patients were evaluated: 67 of them underwent emergency surgery (ES) and 50 underwent BTS. Primary anastomosis rates were 77.6% in ES and 95.7% in BTS (p < 0.001); postoperative complication, 46.3% in ES and 10.5% in BTS (p < 0.001); pathological findings of lymphatic invasion, 66.7% in ES and 100% in BTS (p < 0.001); venous invasion were 66.8% in ES and 92% in BTS (p = 0.04); and recurrence of 25.4% in ES and 39.1% in BTS. The 3-year overall survival was significantly different between two groups (ES, 86.8%:BTS, 58.8%), BTS is worse than ES (log-rank test; p < 0.001). Venous invasion independently predicted worsened recurrence-free and overall survival. Conclusions: The vascular invasiveness was correlated with tumor progression after SEMS placement, and the survival rate was lower in BTS. SEMS potentially worsens prognostic outcomes in stage II–III obstructive colorectal cancer.

Outcomes of Patients with Left-Sided Obstructive Colorectal Cancer: Comparison between Self-Expandable Metallic Stent and Other Treatment Methods

“…Regarding short-term outcomes, patients with SEMS placement had a significantly higher frequency of laparoscopic surgery, lower rate of postoperative stoma creation, shorter postoperative hospital stay, and a greater number of dissected lymph nodes than patients treated with other methods. Previous studies also showed similar results [11,[15][16][17][18][19][20]. Moreover, Yagawa et al [18] showed that the wound infection rate was significantly lower in the SEMS group than in the ER group; however, this was not observed in this study.…”