Korean J Clin Oncol.  2016 Jun;12(1):48-54. 10.14216/kjco.16008.

Oncologic safety of self-expanded metal stent insertion as a bridge to elective surgery in malignant colorectal obstruction

• Oh SH
• Choi NJ
• Seo SH
• An MS
• Kim KH
• Bae KB
• Hwang JW
• Lee SH
• Kim JH
• Jee SR
• Kang MS
• Hong KH

• KMID: 2360703
• DOI: http://doi.org/10.14216/kjco.16008

Abstract

PURPOSE
Colorectal obstruction develops most frequently by carcinoma, and 7%-30% of these colorectal carcinomas are acute cases. The oncologic safety of self-expanding metal stent (SEMS) insertion as a bridge to surgery has not yet been established. Thus, we investigated the oncologic safety of SEMS insertion as a bridge to surgery in patients with obstructive colorectal cancer.
METHODS
This retrospective had 56 patients enrolled requiring emergency management for obstructive colorectal cancer at stage II or III, who had undergone curative surgery between July 2008 and June 2011. These subjects were divided into two groups: patients who had undergone emergency surgery without SEMS insertion (non-stent group) and those who had undergone elective surgery after preoperative decompression with SEMS insertion (stent group). The two groups were compared for clinicopathologic characteristics, postoperative complications, and survival rate.
RESULTS
Enterostomy was performed in 25 patients (100.0%) in the non-stent group and 1 patient (3.2%) in the stent group; laparoscopic surgery was carried out in 7 patients (28.0%) in the non-stent group and 19 patients (61.29%) in the stent group, each showing statistically significant differences. There was no statistically significant difference in postoperative complications and 5-year disease-free survival rate (72% vs. 74.19%, P=0.87, respectively).
CONCLUSION
In treatment of malignant colorectal obstruction, elective operation after stent insertion had similar oncologic outcomes compared with emergency operation. Preoperative stent insertion not only lowers the incidence of enterostomy but also makes laparoscopic surgery possible, thereby enhancing patients' quality of life. Therefore, preoperative stent insertion is a useful method that may replace emergency surgery in treatment of malignant colorectal obstruction.

Keyword

Self-expanding metal stent; Colorectal cancer; Intestinal obstruction; Oncologic outcome

MeSH Terms

Colorectal Neoplasms
Decompression
Disease-Free Survival
Emergencies
Enterostomy
Humans
Incidence
Intestinal Obstruction
Laparoscopy
Methods
Postoperative Complications
Quality of Life
Retrospective Studies
Stents*
Survival Rate