Influence of endoscopists' expertise level on clinical outcomes after bridge-to-surgery stenting in obstructive colorectal cancer.

Abstract

This study aimed to investigate the effect of stenting-related factors, including endoscopists' expertise, on clinical outcomes after bridge-to-surgery (BTS) stenting for obstructive colorectal cancer (CRC). We analyzed BTS stenting-related factors, including stenting expertise and the interval between stenting and surgery, in 233 patients (63 [13] years, 137 male) who underwent BTS stenting for obstructive CRC. We evaluated the influence of these factors on post-BTS stenting clinical outcomes such as stent-related complications and cancer recurrence. The interval between stenting and surgery was ≤7days in 79 patients (33.9%) and >7days in 154 patients (66.1%). BTS stenting was performed by endoscopists with ≤50, 51-100, and >100 prior stenting experiences in 94, 43, and, 96 patients, respectively. The clinical success rate of BTS stenting was 93.1%. Stent-related and postoperative complications developed in 19 (8.2%) and 20 (8.6%) patients, respectively. Cancer recurrence occurred in 76 patients (32.6%). Short BTS interval of ≤7days increased the risk of postoperative complications (odds ratio [OR], 2.61 [1.03-6.75]; P=0.043). Endoscopists' stenting experience >100 showed greater clinical success of stenting (OR, 5.50 [1.45-28.39]; P=0.021) and fewer stent-related complications (OR, 0.26 [0.07-0.80]; P=0.028) compared with stenting experience ≤50. BTS stenting-related factors did not affect long-term oncological outcomes. Greater expertise of endoscopists was associated with better short-term outcomes, including high stenting success rate and low rate of stent-related complications after BTS stenting for obstructive CRC. An interval of >7days between BTS stenting and surgery was required to decrease postoperative complications.