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.

Self-expanding metal stent insertion by colorectal surgeons using a two-person approach colonoscopy without fluoroscopic monitoring in the management of acute colorectal obstruction: a 14-year experience

“…Recent studies found that after SEMS placement as BTS therapy, the laparoscopic approach can be a safe alternative to ES, if the procedure is applied precociously [ 29 ]. Since the first case of laparoscopic surgery in the BTS group on 2012-08-27 in our center, we can now carry out combined organ resection for obstructive colorectal cancer patients with liver metastasis after successful stent decompression, under laparoscopic approach [ 30 ] or minimally invasive small incision [ 31 ]. The BTS group proceeded to resection at a median of 18.5 days (14, 29 days) post-stenting, with a confirmation of malignant histology by biopsy [ 32 ] and without anastomotic leak observed.…”

Colon cancer patient with long-term colon stent placement: Case report and literature review

“…Clinical studies have reported different technical success rates (90.5%-98%) of SEMS stent placement ( 6 , 28 – 31 ). In our center, the success rate is close to 96%.…”