Bridge to surgery using a self-expandable metallic stent for stages II–III obstructive colorectal cancer

• Main Authors: Katsuya Ohta, Masakazu Ikenaga, Masami Ueda, Kiyotsugu Iede, Yujiro Tsuda, Shinsuke Nakashima, Takashi Nojiri, Jin Matsuyama, Shunji Endo, Jun Murata, Ichizo Kobayashi, Masahiko Tsujii, Terumasa Yamada
• Format: Article
• Language: English
• Published: BMC 2020-08-01
• Series: BMC Surgery
• Subjects: Bowel obstruction; Colorectal cancer; Self-expandable metallic stent
• Online Access: http://link.springer.com/article/10.1186/s12893-020-00847-z

Abstract Background Bridge to surgery (BTS) using a self-expandable metallic stent (SEMS) for the treatment of obstructive colorectal cancer improves the patient’s quality of life. This study aimed to examine prognostic factors of obstructive colorectal cancer. Methods We analyzed stage II-III resectable colon cancer cases (Cur A) retrospectively registered between January 2005 and December 2017. Overall, 117 patients with Cur A obstructive colorectal cancer were evaluated: 67 of them underwent emergency surgery (ES Group) and 50 of them after BTS with SEMS placement (BTS group). We compared surgical results and prognoses between the two groups. Results A total of 50 patients underwent endoscopic SEMS placement, which technical success of 96% and morbidity rate of 18%. Primary anastomosis rates were 77.6% in ES and 95.7% in BTS (p <  0.001); postoperative complication, 46.3% in ES and 10.5% in BTS (p <  0.001); pathological findings of lymphatic invasion, 66.7% in ES and 100% in BTS (p <  0.001); venous invasion were 66.8% in ES and 92% in BTS (p = 0.04); and recurrence of 25.4% in ES and 39.1% in BTS. The 3-year overall survival was significantly different between two groups (ES, 86.8%:BTS, 58.8%), BTS is worse than ES (log-rank test; p <  0.001). Venous invasion independently predicted worsened recurrence-free and overall survival. Conclusions The vascular invasiveness was correlated with tumor progression after SEMS placement, and the survival rate was lower in BTS. SEMS potentially worsens prognostic outcomes in stage II–III obstructive colorectal cancer.