Comparison of Short-term Outcomes of a Self-expandable Metallic Stent as a Bridge to Laparoscopic Surgery between Right- and Left-sided Obstructive Colorectal Cancers: A Retrospective Observational Study.

Abstract

Few studies have compared the tumor-site-based postoperative short-term outcomes of a bridge to surgery using self-expandable metallic stents. This study compared the perioperative outcomes following stent placement between right- and left-sided obstructive colorectal cancers, focusing on patients undergoing laparoscopic surgery. This study included 127 patients with stage I-IV obstructive colorectal cancer (right-sided, n = 25 [19.7%]; left-sided, n = 102 [80.3%]) who underwent laparoscopic-assisted surgery following stent placement between May 2012 and September 2021. We compared the postoperative complication rates and the success rates of stent placement. The clinical success rate was not significantly different (92% vs. 97.1%, P = 0.254). The rates of all-grade complications (36% vs. 16.7%, P = 0.05) and postoperative ileus or small-bowel obstruction (20% vs. 2%, P = 0.003) were significantly higher in the right-sided group. The rates of the Clavien-Dindo classification ≥ III complications (8% vs. 6.9%, P = 1) and the median durations of postoperative hospital stay (8 days vs. 8 days, P = 1) were not significantly different. On multivariate analysis, right-sided colon cancer was an independent risk factor for postoperative ileus or small-bowel obstruction (odds ratio [OR]: 16.5, 95% confidence interval [CI]: 2.42-112, P = 0.004) but not for all grades of complications (OR: 2.63, 95% CI: 0.976-7.09, P = 0.056). Although the rates of clinical success, postoperative Clavien-Dindo classification ≥ III severe complications, and postoperative hospital stay were comparable, the bridge to surgery following stent placement for right-sided obstructive colon cancer raises concerns about ileus or small-bowel obstruction.