Self-expandable Metal Stent as a Bridge to Surgery for Colorectal Cancer: Safety and Oncological Outcomes

Abstract

Background/Aim: Self-expandable metal stent (SEMS) as a bridge to surgery (BTS) for obstructive colorectal cancer (CRC) raises concerns regarding the short-term as well as oncological outcome. The present study aimed to investigate the safety of SEMS placement and risk factors of worse short-term and oncological outcomes as BTS. Patients and Methods: Twenty-four patients with obstructive CRC who underwent SEMS placement as BTS were included. Success rate of SEMS placement and 2-year relapse-free survival (RFS) rates in stage II/III BTS patients were assessed. Results: Technical and clinical success rates for SEMS placement were 100% and 87.5%, respectively. In Multivariate analyses, longer tumour length, longer interval to surgery, and angular positioning were risk factors related with the complication of stent placement. Two-year RFS rates were significantly higher in the no-complication than in the complication group (100% vs. 75%, log-rank test, p<0.01). Conclusion: A long tumour length, long interval between SEMS insertion and surgery, and angular positioning of the SEMS were identified as risk factors for SEMS-related complications. Moreover, SEMS insertion and/or surgery complications were associated with worse oncological outcome in CRC patients. Colorectal cancer (CRC) often presents as large bowel obstruction. Traditionally, the treatment of malignant large bowel obstruction is surgery. However, emergency colorectal surgery is associated with high mortality and morbidity rates.

Utility and safety of the self‐expandable metallic colonic stent in Japanese patients who received systemic chemotherapy or palliative treatment for obstructive primary advanced colorectal cancer: A retrospective single‐center medical chart evaluation

“…The utility of colonic stenting has mainly been evaluated on the basis of the surgical outcomes, including long‐term survival and postoperative complications, of Japanese patients who were bridged for curative surgery 2–6,9 . The present study suggests that colonic stenting for decompression for obstructive colorectal cancer is as valuable and effective in patients who undergo systemic chemotherapy and palliative therapy as it is in patients who are bridged for curative surgery, which are partly supported by the findings of previous studies 7,12 …”

“…7,12 Previous studies have demonstrated the safety of colonic stent insertion and have identified the risk factors for stenting in patients who received curative surgery, which include tumor length and staging, the stenosis site of colorectal cancer, the interval to the surgery, and the general condition of the patient, including nutrition status. 6,8,10,16 The present study indicates that colonic stenting for patients who received chemotherapy and palliative therapy was performed safely without serious early complications compared with that for patients who received curative surgery, regardless of risk status for tumor length and staging, stenosis site, survival prognosis, and general condition.…”

“…Regarding surgical outcomes, the advantages and disadvantages of colonic stenting for bridging for surgery were compared with those for emergency surgery and the trans‐anal decompression tube in Japanese studies and were found to be controversial 18–22 . Several studies that focused on the clinical safety and effectiveness of the self‐expandable colonic stent have been conducted in the last 3 years in Japan, most of which were limited to advanced colon cancer patients who were bridged before surgical curative therapy 1–3,5–11 . The present study aimed to compare the utility (technical and clinical success rates) and the safety (rate of early and late complications after stent placement) of the colonic stent between patients who received systemic chemotherapy or palliative treatment and the best supportive care and patients who were bridged for surgery.…”

“…2,3 Decompression by colonic stenting for stenosis in advanced colorectal cancer has been used during bridging before curative surgery and systemic chemotherapy. 3,[5][6][7][8][9][10][11] The technical-and patient-related risk factors for colonic stenting have been identified in several Japanese studies in the last 3 years. [12][13][14][15][16][17] Regarding surgical outcomes, the advantages and disadvantages of colonic stenting for bridging for surgery were compared with those for emergency surgery and the trans-anal decompression tube in Japanese studies and were found to be controversial.…”

Colon or Rectal Stent Positioning for Advanced Cancer Influences Quality of Life: A Critical Point of View

“…Interestingly, although colon or rectal SEMS positioning might be risky because of the eventual serious complications, including perforation, we only recorded some minor complications (3,5). We recommend stent positioning to be performed by experienced staff personnel with a proper preoperative preparation (nasogastric tube and fasting with correction of the fluid and electrolytes imbalance with the intent to reduce the caliber mismatch from above and below the tumor stricture) and selection of the patients amenable of this procedure excluding patients with residual gross colonic dilatation, in whom there is a persistent significant risk of perforation and/or ischemia, and can undergo conventional surgery (3,5,13,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29).…”