Abstract
PurposeMalignant large-bowel obstruction (MLBO) is a highly urgent condition in colorectal cancer with high complication rates. Self-expandable metal stent (SEMS) placement in MLBO is a new decompression treatment in Japan. Preoperative stent placement (bridge to surgery: BTS) avoids emergency surgery, but oncological influences of stent placement and post-BTS surgical approach remain unclear. We examined short- and long-term results of surgery for MLBO after SEMS placement in our hospital.MethodsWe retrospectively reviewed 75 patients with MLBO who underwent resection after SEMS placement at our hospital from June 2013 to December 2018. Postoperative morbidity and mortality were evaluated by comparison with the surgical approach.ResultsTumor location was significantly higher in the left-side colon and rectum (n = 59, 78.7%) than right-side colon (n = 16, 21.3%). Technical and clinical success rates for SEMS placement were 97.3% and 96.0%, respectively. Laparoscopic surgery was performed in 54 patients (69.0%), and one-stage anastomosis was performed in 73 (97.3%). Postoperative complications were similar in the open surgery (open) group (n = 5, 23.8%) and laparoscopic surgery (lap) group (n = 7, 13.0%), with no severe complications requiring reoperation. Three-year overall survival (OS) and relapse-free survival (RFS) rates were not significantly different in the lap vs open group (67.5% vs 66.4%; 82.2% vs 62.5%).ConclusionPreoperative stent treatment avoids stoma construction but allows anastomosis. One-time surgery was performed safely contributing to minimally invasive treatment and acceptable short- and long-term results.
Highlights
Colorectal cancer is the fourth most common malignant disease and the fifth most frequent cause of cancerrelated deaths worldwide [1]
Laparoscopic surgery was performed in 54 patients (69.0%), and one-stage anastomosis was performed in 73 (97.3%)
No direct comparison with emergency surgery was made in this study, no significant difference in either short-term or long-term prognosis of colorectal cancers has been reported in the past
Summary
Colorectal cancer is the fourth most common malignant disease and the fifth most frequent cause of cancerrelated deaths worldwide [1]. MLBO is reported in 3–29% of all colorectal cancers, and is not a rare condition but one that is frequently encountered clinically [2,3,4,5,6]. MLBO is a highly urgent condition [6], and the complication rate following emergency surgery ranges as high as 30–60% [8]. Many patients eventually progress to a permanent stoma, which greatly lowers quality of life. From this background, transanal drainage or colonic stent placement has begun to be performed to avoid emergency surgery [9,10,11]
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