Short- and long-term outcomes after colonic self-expandable metal stent placement for malignant large-bowel obstruction as a bridge to surgery focus on the feasibility of the laparoscopic approach: a retrospective, single center study

Abstract

Purpose Malignant large-bowel obstruction (MLBO) is a highly urgent condition in colorectal cancer with high complication rates. Self-expandable metal stent (SEMS) placement in MLBO is a new decompression treatment in Japan. Preoperative stent placement (bridge to surgery: BTS) avoids emergency surgery, but oncological influences of stent placement and post-BTS surgical approach remain unclear. We examined short- and long-term results of surgery for MLBO after SEMS placement in our hospital.Methods We retrospectively reviewed 75 patients with MLBO who underwent resection after SEMS placement at our hospital from June 2013 to December 2018. Postoperative morbidity and mortality were evaluated by comparison with the surgical approach.Results Tumor location was significantly higher in the left-side colon and rectum (n=59, 78.7%) than right-side colon (n=16, 21.3%). Technical and clinical success rates for SEMS placement were 97.3% and 96.0%, respectively. Laparoscopic surgery was performed in 54 patients (69.0%), and one-stage anastomosis was performed in 73 (97.3%). Postoperative complications were similar in the open surgery (Open) group (n=5, 23.8%) and laparoscopic surgery (Lap) group (n=7, 13.0%), with no severe complications requiring reoperation. Three-year overall survival (OS) and relapse-free survival (RFS) rates were not significantly different in the Lap vs Open group (67.5% vs 66.4%; 82.2% vs 62.5%).Conclusion Preoperative stent treatment avoids stoma construction but allows anastomosis. One-time surgery was performed safely contributing to minimally invasive treatment and acceptable short- and long-term results.

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 technical‐ and patient‐related risk factors for colonic stenting have been identified in several Japanese studies in the last 3 years 12–17 . 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 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 .…”

“…[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. [18][19][20][21][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][2][3][5][6][7][8][9][10][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.…”