Long-term outcomes after stenting as a bridge to surgery in patients with obstructing left-sided colorectal cancer

Int J Colorectal Dis. 2018 Jun;33(6):799-807. doi: 10.1007/s00384-018-3009-7. Epub 2018 Mar 12.

Abstract

Purpose: Self-expandable metallic stents (SEMS) may be used in acute, obstructing, left-sided colorectal cancer (CRC) to avoid high-risk emergency surgery. However, the data regarding the long-term effects of SEMS as a bridge to surgery are limited and contradictory. Our aim is to analyze the long-term oncological outcomes of SEMS compared with surgery.

Methods: Between January 2006 and November 2013, a total of 855 patients with stage III CRC were regularly followed at the CRC clinic of Severance Hospital, Seoul, Korea. We retrospectively evaluated their 5-year disease-free survival (DFS), 5-year overall survival (OS), and 5-year cancer-specific survival (CSS).

Results: There were 94 patients in the SEMS group, 17 in the emergent-surgery group, and 744 in the elective-surgery group. In the short term, the rate of permanent stoma formation was significantly higher in the emergent-surgery group than in the SEMS group (p = 0.030), although the median hospital stay and overall complication rate were comparable. During the long-term follow-up period, oncological outcomes including 5-year DFS (70.2 vs 52.9%; p = 0.210), OS (70.2 vs 52.9%; p = 0.148), and CSS (79.8 vs 70.6%; p = 0.342) were not different between the SEMS group and the emergent-surgery group. Multivariate analysis showed emergent operation to be a significant risk factor of DFS (hazard ratio [HR], 3.117; 95% confidence interval [CI], 1.498-6.489; p = 0.002).

Conclusions: Preoperative SEMS insertion does not adversely affect long-term oncological outcomes or patient survival.

Keywords: Bridge to surgery; Colorectal neoplasms; Outcome; SEMS.

MeSH terms

  • Aged
  • Colorectal Neoplasms / surgery*
  • Demography
  • Disease-Free Survival
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / pathology
  • Perioperative Care
  • Proportional Hazards Models
  • Stents*
  • Time Factors
  • Treatment Outcome