Abstract
A bridge to surgery (BTS) after a colonic stent for obstructive colon cancer has not been accepted as a standard treatment strategy. Also, there is no consensus regarding the optimal time interval for BTS. We aimed to identify the optimal timing for BTS after stent placement to decrease the oncologic risk. We retrospectively collected data of 174 patients who underwent BTS after stent placement for stage II or III obstructive colon cancer from five hospitals. We divided the patients into three groups based on the time interval for BTS after stent placement: within 7 days (Group 1), from 8 to 14 days (Group 2), and after 14 days (Group 3). The primary outcome was to compare the oncologic outcomes including overall survival (OS), disease-free survival (DFS), and recurrence rate (RR) among the three groups. Groups 1, 2, and 3 involved 75, 56, and 43 patients, respectively. Postoperative morbidity rates were 17.3%, 10.8%, and 9.3% in Groups 1, 2, and 3, respectively (P = 0.337). RRs were 16.0%, 35.7%, and 30.2% in Groups 1, 2, and 3, respectively (P = 0.029). In multivariate analysis, the time interval for BTS was an independent risk factor for DFS (P < 0.001; HR, 14.463; 95% CI, 1.458–3.255) and OS (P = 0.027; HR, 4.917; 95% CI, 1.071–3.059). In conclusion, the perioperative short-term outcome was not affected by the time interval of BTS. However, elective surgery within 7 days after colonic stent might be suggested to balance the short-term benefits and long-term oncologic risks.
Highlights
A bridge to surgery (BTS) after a colonic stent for obstructive colon cancer has not been accepted as a standard treatment strategy
We aimed to find out the optimal timing of elective surgery after colonic stenting in patients with obstructing colon cancer by comparing the short- and long-term outcomes among three groups based on the time interval between self-expandable metal stent (SEMS) placement and elective surgery
The BTS was first introduced by Dohmoto et al in 1990 to manage the acute phase of malignant colonic obstruction[11]
Summary
A bridge to surgery (BTS) after a colonic stent for obstructive colon cancer has not been accepted as a standard treatment strategy. Minutes no Combined resection yes no Stoma creation yes Theoretically, a delayed interval between SEMS placement and definitive surgery allows for better recovery and improved nutritional status to decrease postoperative morbidity, but this may increase the risk of stent-related complications and can make an elective surgery more difficult by more local tumor infiltration and fibrosis It is a weak recommendation with low-quality evidence, ESGE Clinical Guidelines recommend that the time interval to surgery of 5–10 days is suggested when SEMS is used as BTS in patients with potentially curable colon cancer.[9] Several studies with longer interval of >7 days for BTS demonstrated that higher recurrence rates were shown in the SEMS group than in the emergency surgery group[6,8,10]. We aimed to find out the optimal timing of elective surgery after colonic stenting in patients with obstructing colon cancer by comparing the short- and long-term outcomes among three groups based on the time interval between SEMS placement and elective surgery
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