Abstract
PurposeAdvances in endoscopic technology have led to the reevaluation of self-expandable metallic stent (SEMS) placement as a bridge-to-surgery (BTS) in patients with obstructive colorectal cancer. In Japan, after inclusion of SEMS placement as a BTS in the medical insurance coverage in 2012, this procedure has been increasingly performed. However, a transanal decompression tube (TADT) placement has been used as a BTS. We aimed to retrospectively evaluate the optimal strategy for obstructive left-sided colorectal cancer (OLCRC) by comparing SEMS and TADT placement with emergency surgery.MethodsWe included 301 patients with stage II and III OLCRC from 27 institutions. The study patients were divided into Surgery group (emergency surgery, n = 103), SEMS group (BTS by SEMS, n = 113), and TADT group (BTS by TADT, n = 85). We compared the survival and perioperative outcomes of patients in the Surgery group as a standard treatment with those in the SEMS and TADT groups.ResultsThe 3-year relapse-free survival rate in patients in the Surgery group was 74.8%, while that in patients in the SEMS group and TADT group were 69.0% (p = 0.39) and 55.3% (p = 0.006), respectively. The technical success rate was not statistically different, but the clinical success rate was significantly higher in the SEMS group than in the TADT group (p = 0.0040). With regard to postoperative complications after curative surgery, the SEMS group had significantly lower of complications (≥ grade 2) than the Surgery group (p = 0.022).ConclusionPatients who underwent SEMS placement for OLCRC had similar oncological outcomes to patients who underwent emergency surgery.
Highlights
Colorectal cancer (CRC) is the most common cancer in the gastrointestinal tract in the world [1]
There were no significant differences in age and gender between the Surgery group and the self-expandable metallic stent (SEMS)/transanal decompression tube (TADT) group
No difference was found in the proportion of patients of stage II and III between the Surgery group and the SEMS group, the rate of stage III was significantly higher in the TADT group than that of the Surgery group (p = 0.019)
Summary
Colorectal cancer (CRC) is the most common cancer in the gastrointestinal tract in the world [1]. The incidence of obstruction in left-sided CRC was reported to be higher than that in right-sided CRC. 8–16% of CRC patients initially present with bowel obstruction, which accounts for 85% of colonic emergencies [1, 2]. Treatment for obstructive leftsided CRC (OLCRC) has been an emergency surgery including stoma creation for colonic decompression [3]. The emergency surgical procedure is associated with higher rates of mortality and morbidity compared to elective surgical procedure [4, 5].
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