Stent as bridge to surgery decreases postoperative complications without worsening oncological outcomes: retrospective unicentric cohort study and stent placement protocol

• Published in: Surgical endoscopy Vol. 37; no. 8; pp. 6298 - 6307
• Main Authors: Paniagua García-Señoráns, Marta, Sánchez Santos, Raquel, Cano Valderrama, Óscar, Vigorita, Vincenzo, de Castro Parga, Maria Luisa, Cea Pereira, Sonia, Rodríguez Fernández, Laura, Moncada Iribarren, Enrique
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.08.2023; Springer Nature B.V
• Subjects: Abdominal Surgery; Cohort analysis; Cohort Studies; Colonic Neoplasms - complications; Colonic Neoplasms - surgery; Colorectal cancer; Colorectal Neoplasms; Colorectal surgery; Gastroenterology; Gynecology; Hepatology; Humans; Intestinal Obstruction - etiology; Intestinal Obstruction - surgery; Medicine; Medicine & Public Health; Mortality; Oncology; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Postoperative period; Proctology; Retrospective Studies; Self Expandable Metallic Stents - adverse effects; Stents; Stents - adverse effects; Surgery; Treatment Outcome; Colorectal; Emergency; Protocol; Stent; Surgery; Cancer
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-023-10091-0

Background Even if the use of stent as bridge to surgery (BTS) for obstructive colon cancer was described long ago, there is still much controversy on their use. Patient recovery before surgery and colonic desobstruction are just some of the reasons to defend this management that can be found in several available articles. Methods This is a single-center, retrospective cohort study, including patients with obstructive colon cancer treated between 2010 and 2020. The primary aim of this study is to compare medium-term oncological outcomes (overall survival, disease-free survival) between stent as BTS and ES groups. The secondary aims are to compare perioperative results (in terms of approach, morbidity and mortality, and rate of anastomosis/stomas) between both groups and, within the BTS group, analyze whether there are any factors that may influence oncological outcomes. Results A total of 251 patients were included. Patients belonging to the BTS cohort presented a higher rate of laparoscopic approach, required less intensive care management, less reintervention, and less permanent stoma rate, when comparing with patients who underwent urgent surgery (US). There were not significant differences in terms of disease-free survival and overall survival between the two groups. Lymphovascular invasion negatively affected oncological results but was not related with stent placement. Conclusion The stent as a bridge to surgery is a good alternative to urgent surgery, which leads to a decrease in postoperative morbidity and mortality without significantly worsening oncological outcomes. Graphical abstract