Abstract
Background Self-expanding metal stents (SEMS) have been increasingly used in patients with obstructive left-sided colorectal cancer (OLCC); however, stent-specific complications (e.g., perforations) might worsen the long-term survival outcome. Strict indication needed to be identified to confirm the benefit subgroups. This study was designed to explore the indication for emergency surgery (ES) and SEMS in patients with OLCC and to suggest optimal strategies for individuals. Methods After propensity score matching, 36 pairs were included. Perioperative and long-term survival outcomes (3-year overall survival (OS) and 3-year disease-free survival (DFS)) were compared between the ES and SEMS groups. Independent risk factors were evaluated among subgroups. Stratification survival analysis was performed to identify subgroups that would benefit from SEMS placement or ES. Results The perioperative outcomes were similar between the SEMS and ES groups. The 3-year OS was comparable between the SEMS (73.5%) and ES (60.0%) groups, and the 3-year DFS in the SEMS group (69.7%) was similar to that in the ES group (57.1%). The pT stage was an independent risk factor for 3-year DFS (p = 0.014) and 3-year OS (p = 0.010) in the SEMS group. The comorbidity status (p = 0.049) independently affected 3-year DFS in the ES group. The 3-year OS rate was influenced by the cM stage (p = 0.003). Patients with non-pT4 stages in the SEMS group showed obviously better 3-year OS (95.0%) than the other subgroups. The 3-year OS rate was 36.4% in the ES group when patients had a worse comorbidity status than their counterparts. Conclusion SEMS might be preferred for patients of obstructive left-sided colorectal cancer in the “high-operative risk group” with existing comorbidities or those without locally advanced invasion, such as the non-pT4-stage status.
Highlights
Obstructive left-sided colon cancer (OLCC) is the primary cause of acute malignant colonic obstruction, with an incidence rate ranging from 58% to 80% [1,2,3]
Several strategies, including emergency Hartmann’s procedures, emergency surgery (ES) with stoma construction followed by a staged procedure, ES with intraoperative irrigation or manual decompression, and self-expandable metal stents (SEMS) as a bridge to surgery (BTS), have been introduced in the treatment of obstructive left-sided colorectal cancer (OLCC), the best option remains elusive [4,5,6,7,8,9]
All diagnoses of left-sided colorectal obstruction were confirmed by emergency abdominal computed tomography (CT), and diagnoses of malignancy were confirmed by pathological examination; all stage IV patients underwent radical resection for distant metastasis lesions
Summary
Obstructive left-sided colon cancer (OLCC) is the primary cause of acute malignant colonic obstruction, with an incidence rate ranging from 58% to 80% [1,2,3]. Several randomized controlled trials and multicenter prospective studies recently ended prematurely due to the extremely high rates of stent-related perforation, which worsened the long-term survival results and increased the risk of recurrence [13,14,15,16]. These adverse effects hinder the widespread use of SEMS in the treatment of OLCC. Self-expanding metal stents (SEMS) have been increasingly used in patients with obstructive left-sided colorectal cancer (OLCC); stent-specific complications (e.g., perforations) might worsen the long-term survival outcome. SEMS might be preferred for patients of obstructive left-sided colorectal cancer in the “high-operative risk group” with existing comorbidities or those without locally advanced invasion, such as the non-pT4-stage status
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