Efficacy and safety of self-expanding metallic stent placement followed by neoadjuvant chemotherapy and scheduled surgery for treatment of obstructing left-sided colonic cancer

Abstract

Background: This study aimed to evaluate the safety and feasibility of self-expanding metallic stent (SEMS) followed by neoadjuvant chemotherapy prior to elective surgery for obstructing left-sided colon cancer. Methods: Eleven consecutive patients with obstructing left-sided colon cancer between May 2014 and November 2015 were included retrospectively. All patients received SEMS followed by neoadjuvant chemotherapy. The primary outcome measure was stoma and laparoscopic surgery. Results: Chemotherapy was with two cycles of CAPOX (54.5%) or three cycles mFOLFOX6 (45.5%). Median serum albumin and hemoglobin levels before surgery were significantly higher than before neoadjuvant chemotherapy (p = 0.01 and p = 0.008 respectively) and before SEMS (p = 0.01 and p = 0.003 respectively). Median bowel wall thickness proximal to the upper edge of tumor was significantly more before neoadjuvant chemotherapy than before stent (p = 0.003), and significantly less before surgery than before neoadjuvant chemotherapy (p = 0.003). No patient underwent stoma creation. Laparoscopic surgery was performed in nine (81.8%) patients. No local recurrence or metastases developed over median cancer-specific follow-up of 44 months (range, 37-55 months). Conclusion: SEMS followed by neoadjuvant chemotherapy prior to elective surgery appears to be safe and well tolerated in patients with obstructing left-sided colon cancer.

Efficacy of Laparoscopic Radical Resection Combined with Neoadjuvant Chemotherapy and Its Impact on Long-Term Prognosis of Patients with Colorectal Cancer

“…In recent years, the detection of serum tumor markers in CC patients carries considerable implications for the diagnosis, assessment of therapeutic efficacy, and prognostic outcome of oncological disease in clinic. CEA and CA199 are frequently used as clinical markers for the assessment of oncological disease, and their levels may be utilized to identify the tumor staging as well as the prognosis of the patients [ 19 , 20 ]. In this study, the postoperative levels of CEA and CA199 were significantly lower in the combined group than in the surgical group, suggesting that preoperative neoadjuvant chemotherapy could be effective in improving the serum levels of CC patients, which in turn improved the prognosis of the patients.…”

Stent as a bridge to surgery versus urgent surgery for malignant right colonic obstruction: A multicenter retrospective study

“…As previously described, 11 SEMS (WallFlex; Boston Scientific Corporation, Natick, MA, USA) was inserted under fluoroscopic guidance. Stent expansion and position were confirmed with abdominal radiography.…”

Management of obstructive colon cancer: Current status, obstacles, and future directions

“…The use of neoadjuvant chemotherapy after SEMS placement in patients with potentially curable obstructive colon cancer is rare. Only one retrospective analysis with a small sample size ( n = 9) was found[ 73 ]. In this study, the efficacy and safety of SEMS insertion followed by neoadjuvant chemotherapy and elective surgery were evaluated, and the study results revealed relatively low toxicity, high adherence to two to three cycles of neoadjuvant chemotherapy before elective surgery and no evidence of perineural invasion in resected specimens[ 73 ].…”

“…Only one retrospective analysis with a small sample size ( n = 9) was found[ 73 ]. In this study, the efficacy and safety of SEMS insertion followed by neoadjuvant chemotherapy and elective surgery were evaluated, and the study results revealed relatively low toxicity, high adherence to two to three cycles of neoadjuvant chemotherapy before elective surgery and no evidence of perineural invasion in resected specimens[ 73 ]. The authors suggested that neoadjuvant chemotherapy may lower the risk of perineural invasion, possibly improving survival outcomes[ 73 ].…”

“…In this study, the efficacy and safety of SEMS insertion followed by neoadjuvant chemotherapy and elective surgery were evaluated, and the study results revealed relatively low toxicity, high adherence to two to three cycles of neoadjuvant chemotherapy before elective surgery and no evidence of perineural invasion in resected specimens[ 73 ]. The authors suggested that neoadjuvant chemotherapy may lower the risk of perineural invasion, possibly improving survival outcomes[ 73 ]. In the FOXTROT trial, a randomized controlled trial evaluating the efficacy of neoadjuvant chemotherapy in locally advanced colon cancer, a few patients underwent SEMS placement as a bridge to surgery, and the results showed a significant decrease in the R1 resection rate and a nonsignificant trend toward better oncological outcomes at two years[ 70 ].…”