Ann Coloproctol.  2022 Jun;38(3):235-243. 10.3393/ac.2020.01067.0152.

Comparison of the oncological outcomes of stenting as a bridge to surgery and surgery alone in stages II to III obstructive colorectal cancer: a retrospective study

• Uehara H
• Yamazaki T
• Iwaya A
• Kameyama H
• Komatsu M
• Hirai M

• KMID: 2531262
• DOI: http://doi.org/10.3393/ac.2020.01067.0152

Abstract

Purpose
We evaluated the oncological outcomes of bridge to surgery (BTS) using stent compared with surgery alone for obstructive colorectal cancer.
Methods
Consecutive patients who underwent curative resection for stages II to III obstructive colorectal cancer at our institution from January 2009 to March 2020, were registered retrospectively and divided into 43 patients in the BTS group and 65 patients in the surgery alone group. We compared the surgical and oncological outcomes between the 2 groups.
Results
Stent-related perforation did not occur. One patient in whom the stent placement was unsuccessful underwent emergency surgery with poor decompression (clinical success rate, 97.7%). The pathological characteristics were not significantly different between the groups. The following surgical outcomes in the BTS group were superior to those in the surgery alone group; nonemergency surgery (P<0.001), surgical approach (P=0.006), and length of hospital stay (P=0.020). The median follow-up time was 44.9 months (range, 1.1–126.5 months). The 3-year relapse-free survival rates were 68.4% and 58.2% (P=0.411), and the overall survival rates were 78.3% and 88.2% (P=0.255) in the surgery alone and BTS groups, respectively. The 3-year locoregional recurrence rates were 10.2% and 8.0% (P=0.948), and distant metastatic recurrence rates were 13.3% and 30.4% (P=0.035) in the surgery alone and BTS groups, respectively.
Conclusion
This study revealed that BTS with stent may be associated with a higher frequency of distant metastatic recurrence. Stent for stages II to III obstructive colorectal cancer potentially worsens oncological outcomes.

Keyword

Obstructive colorectal cancer; Stents; Bridge to surgery; Distant metastatic recurrence