Elective Surgery After Endoscopic Self-Expandable Metallic Stent Placement for Patients With Obstructive Colon Cancer: Preoperative Systemic Evaluation and Management

Abstract

One-stage curative surgical resection for obstructive colon cancer is challenging. Selfexpandable metallic stents (SEMSs) are known as an alternative treatment used to avoid emergency operation. We aimed to evaluate the significance of SEMS placement as a bridge to surgery and the surgical outcomes of the elective operation. A consecutive 20 patients with obstructive colon cancer undergoing SEMS placement between June 2014 and February 2016 were included. The technical outcomes of the SEMS placement, surgical procedures, and surgical outcomes were evaluated retrospectively. Among them, 2 patients were treated with a SEMS palliatively, and the others were treated with a SEMS as a bridge to surgery. All SEMS were placed successfully at the first attempt, and there was no SEMS-related complication. Before surgery, all patients could be diagnosed histologically, and they were evaluated systemically including proximal colon or distant metastasis. The median time to operation after SEMS placement was 14 days (range 9-20Corresponding author: Hajime Matsushima, Department of Surgery, Nagasaki Rosai Hospital, 2-12-5 Setogoshi, Sasebo, 857-0134, Japan.Tel.: 81-956-49-219181-956-49- , Fax: 81-956-49-2358 E-mail: h.matsushima.1020@gmail.com Int Surg 2017;102 21 days). Seven of the 18 patients underwent a laparoscopic colectomy without conversion to laparotomy. All patients with stage II or III colon cancer underwent curative surgery, and 2 patients with stage IV colon cancer underwent a one-stage resection of the primary colon cancer and simultaneous liver metastasis after the evaluation of hepatic functional reserve. There was no mortality or SEMS-related complication in the perioperative period. SEMS placement as a bridge to surgery for patients with obstructive colon cancer is safe and effective to provide an adequate amount of time for a preoperative systemic management and evaluation.Key words: Colorectal cancer -Malignant colonic obstruction -Self-expandable metallic stent -Bridge to surgery -Palliation C olorectal cancer is a common malignancy, and more than 1 million cases are diagnosed annually worldwide.1 Although the use of screening programs has spread, 8%-29% of colorectal cancer patients are diagnosed in emergency status due to a large bowel obstruction.2,3 The treatment for obstructive colorectal cancer is still controversial. 4Emergency operations such as Hartman's procedure and colostomy have conventionally been performed for patients with obstructive colorectal cancer, but high mortality and morbidity rates remain for this malignancy. 5,6 There are 2 important problems regarding the preoperative evaluation of obstructive colorectal cancer: synchronous colon cancer and liver metastasis. The incidence of synchronous colon cancers in patients diagnosed with colorectal cancer has been reported to be 2% to 10.7%, 7,8 and synchronous liver metastasis has been identified in 20%-30% of patients with primary colorectal cancers.9,10 The preoperative evaluation of the total colon to the proximal part of the obstru...