Long-term outcomes of colonic stent as a "bridge to surgery"for left-sided malignant large-bowel obstruction

• Published in: Surgical oncology 2020-12, Vol.35, p.399-405
• Main Authors: Mora-López, L., Hidalgo, M., Falcó, J., Serra-Pla, Sh, Pallisera-Lloveras, A., Garcia-Nalda, A., Criado, E., Navarro-Soto, S., Serra-Aracil, X.
• Format: Article
• Language: English
• Subjects: Anastomosis; Anastomotic leak; Cancer surgery; Colon; Colon cancer; Colorectal cancer; Hospitals; Implants; Informed consent; Intestinal obstruction; Intestine; Laparoscopy; Left-sided malignant obstruction; Morbidity; Mortality; Ostomy; Patients; Society; Stent as a bridge to surgery; Stents; Success; Surgery; Survival
• ISSN: 0960-7404; 1879-3320
• DOI: 10.1016/j.suronc.2020.09.025

The role of self-expandable metallic stents (SEMS) as a bridge to surgery in left-sided malignant colonic obstruction is still debated. Here we assess the morbidity, mortality and long-term oncological outcomes as a bridge to surgery for patients with left-sided malignant colonic obstruction. Prospective observational study with retrospective analysis of patients with left-sided malignant colonic obstruction undergoing stenting. April 2006–April 2018. We assessed all patients with intent-to treat and per protocol analyses and long-term follow-up variables. Colonic stent was performed in 117 patients. Technical and clinical success of SEMS placement: 94.4% (111/117), only 4.3% perforation. Elective surgery resection following the strategy of SEMS was performed in 83.8% (98/117). A laparoscopic approach was: 25.6% (30/117); 76.9% in the last two years. Primary anastomosis rate: 92.8% (91/98), without protective stoma in any patients. Anastomotic leakage rate: 8.2% (8/97). Median follow-up: 44.5 months (range 0–109). The intent-to-treat analysis showed overall and disease-free survival rates of 63.3% (74/117) and 58.1% (68/117), and local and distant recurrence rates: 9.4% (11/117) and 58.1% (68/117). In the per protocol analysis, overall and disease-free survival rates: 63.2% (62/98) and 60.2% (58/98), and local and distant recurrence rates: 10.2% (10/98) and 36.7% (36/98). Disease progression was predominantly observed during the first 5 years' follow-up as disease recurrence; after five years' follow-up, 60% of the patients were disease-free. According to the results of the study SEMS as a bridge to surgery achieves perioperative results comparable to non-occlusive colonic cancer surgery and does not adversely affect long-term oncological outcomes. Further investigations are needed. •Stent as a bridge to surgery (SEMS) allows the performance of a scheluded surgery.•Onocological outcomes after surgery with SEMS are similar to non-oclusive colonic cancer surgery.•In experienced hands, SEMS is a valid option in treatment of malignant colonic obstruction.