A Bridge to Curative Surgery for Obstructive Colorectal Cancer: Self-expandable Metallic Stent Versus Decompression Tube

• Published in: Anticancer research Vol. 44; no. 8; pp. 3427 - 3441
• Main Authors: Takahashi, Hiroyuki, Kojima, Daibo, Wada, Hideo, Hanaoka, Katsuzo, Watanabe, Toshifumi, Nagano, Hideki, Yamakado, Jin, Matsuda, Aoi, Irie, Hisatoshi, Maki, Toshimitsu, Hamahata, Keisuke, Hayashi, Takaomi, Hirano, Yosuke, Kaida, Hiroki, Kawamoto, Makoto, Shibata, Ryosuke, Miyasaka, Yoshihiro, Higashi, Daijiro, Watanabe, Masato
• Format: Journal Article
• Language: English
• Published: Greece International Institute of Anticancer Research 01.08.2024
• Subjects: Aged; Aged, 80 and over; Cancer; Colorectal cancer; Colorectal carcinoma; Colorectal Neoplasms - complications; Colorectal Neoplasms - pathology; Colorectal Neoplasms - surgery; Complications; Decompression; Decompression, Surgical - methods; Female; Hospitals; Humans; Implants; Intestinal Obstruction - etiology; Intestinal Obstruction - surgery; Laparoscopy; Male; Middle Aged; Ostomy; Patients; Postoperative; Postoperative Complications - etiology; Retrospective Studies; Self Expandable Metallic Stents - adverse effects; Stents; Surgery; Survival; Treatment Outcome; self-expandable metallic stent; Obstructive colorectal cancer; decompression tube; bridge to surgery
• ISSN: 0250-7005; 1791-7530; 1791-7530
• DOI: 10.21873/anticanres.17163

Self-expandable metallic stent (SEMS) placement is becoming the standard bridge-to-surgery (BTS) strategy for potentially curable left-sided obstructive colorectal cancer (OCRC). The study objective was to evaluate the effectiveness of SEMS placement as a BTS strategy for both right- and left-sided OCRC. We retrospectively compared the short- and long-term outcomes of patients with OCRC who underwent placement of a SEMS versus a trans-nasal/anal decompression tube (DCT). The cohort comprised 57 patients with stage II/III right-sided OCRC (DCT, n=20; SEMS, n=8) or left-sided OCRC (DCT, n=9; SEMS, n=20). The short-term outcomes were the incidence of postoperative complications, rate of laparoscopic surgery, rate of stoma construction, and postoperative hospital stay; long-term outcomes were the 3-year overall survival (OS) and relapse-free survival (RFS). The SEMS group had a higher rate of laparoscopic surgery (85.7% vs. 6.9%, p<0.001), lower rate of stoma construction (10.7% vs. 34.5%, p=0.03), and shorter postoperative hospital stay (14 vs. 17 days, p=0.04) than the DCT group. Both groups had a similar incidence of postoperative complications. The 3-year OS and RFS were also similar in the DCT and SEMS groups for both right-sided OCRC (OS, 75.0% vs. 87.5%, HR=1.51, 95% CI=0.22-10.25, p=0.7; RFS, 65.0% vs. 50.0%, HR=0.97, 95% CI=0.28-3.36, p=0.9) and left-sided OCRC (OS, 88.8% vs. 90.0%, HR=1.19, 95% CI=0.10-14.29, p=0.9; RFS, 77.8% vs. 85.0%, HR=1.03, 95% CI=0.16-6.5, p=0.9). SEMS placement is a reasonable BTS strategy for left- and right-sided OCRC that achieves comparable short- and long-term outcomes to DCT insertion.