P-266 Oncological outcomes of self-expanding metal stent as a bridge to surgery for obstructive left-sided colon cancer

Abstract

Self-expandable metallic stents (SEMS) are used as a bridge to surgery in patients with obstructive colon cancer. However, outcomes associated with stent-related perforation and the optimal timing from stenting to elective surgery remain unknown, and there are still concerns on the oncological safety. The aim of our study was to assess the long-term oncological outcomes as well as surgical morbidity of patients treated with SEMS for left-sided obstructive colon cancer as a bridge to surgery. A prospective database of patients who underwent SEMS placement between 2005 and 2019 was retrospectively reviewed. A subgroup of stage I-III SEMS patients were matched for sex, age, ASA, and oncological stage with patients (ratio 1:2) who underwent elective surgery for left-sided colon cancer operated on with curative intention. Patient demographics, tumor characteristics, stoma formation, morbidity, and oncological outcomes were analyzed. A total of 45 SEMS patients were included, and matched with 90 patients who underwent elective surgery of left-sided colon cancer. Both groups were comparable with respect to age, sex, ASA, BMI, preoperative albumin, and pathological stage. The median time from SEMS to surgery was 12.3 +/- 6.5 days (4-36). There were no statistically significant differences between the SEMS group and the elective group regarding the following: laparoscopic approach (71.7 % vs 77.8%, p=0.4), anastomotic leakage rate (6.7% vs 3.3%, p=0.4), postoperative hospital stay (mean 11.6 vs 9.8 days, p=0.36), overall morbidity according the Clavien-Dindo classification (p=0.85) perforation rate on pathological examination (6.7% vs 4.4%, p=0.69), and adjuvant chemotherapy (66.7% vs 64.4%, p=0.85). A temporary protective ileostomy was performed in three patients in the SEMS group, while none of the elective group had a stoma (6.7% vs 0.0%, P=0.035). There were no statistically significant differences between groups regarding overall survival (Log Rank = 0.075) and the 3-and 5-year disease-free survival. In our experience, the use of SEMS as a bridge to surgery is a safe option with long-term oncological outcomes similar to non-oclusive colon cancer elective surgery. Timing of surgery after stent placement represents probably a crucial step and should be further investigated.