Impact of endoscopic metallic stent placement and emergency surgery on detection of viable circulating tumor cells for acute malignant left-sided colonic obstruction

Abstract

Background: Self-expanding metal stents (SEMS) served as a bridge to surgery (BTS). However, this method may be associated with worse long-term prognosis and relapse of CRC patients. Therefore, we attempted to clarify this in the angle of Circulating tumor cells (CTCs). Methods: A multicenter study was performed from March 2018 to January 2021. 32 colorectal cancer patients with obstruction were selected, of which 21 patients were performed SEMS as a BTS while 11 patients were performed emergency surgery.Bloods samples were collected in two groups of patients for further detecting CTCs. In SEMS group, the samples were collected before and after stent insert and after radical surgery performed. In ES group, the samples were collected before stent insert and after emergency surgery performed. Results: The number of CTCs did not show statistically significant differences before and after stent placement (34.90 vs 38.33, p=0.90), neither between the SEMS group and ES group in initial CTC levels (34.90 vs 58.09, p=0.394). No significant differences (38.33 vs 58.09, p=0.632) were observed after stent insert in SMES group and the initial CTC levels in ES group. Moreover, no major differences (24.17 vs 42.27, p=0.225) were observed after radical operation performed in both groups. Conclusion: The treatment of SEMS does not cause an increase in the number of CTC after stent insertion. Furthermore, there aremay be other factors besides CTC to cause these poorer oncologic outcomes after SEMS placement.