Delaying surgery for optimization after colonic stent bridging is safe for left-sided malignant large bowel obstruction: Result from 10-year experience and risks factor analysis

• Published in: Surgical oncology 2023-04, Vol.47, p.101918-101918, Article 101918
• Main Authors: Ho, Man-fung, Futaba, Kaori, Chu, Simon, Hon, Sophie Sok-fei, Ng, Simon Siu-man
• Format: Article
• Language: English
• Subjects: Adverse effects; Colon; Colonic Neoplasms - complications; Colonic Neoplasms - pathology; Colonic Neoplasms - surgery; Colorectal neoplasms; Colorectal Neoplasms - complications; Colorectal Neoplasms - surgery; Etiology; Factor Analysis, Statistical; Humans; Intestinal obstruction; Intestinal Obstruction - etiology; Intestinal Obstruction - pathology; Intestinal Obstruction - surgery; Rectal Neoplasms; Retrospective Studies; Self-expandable metallic stents; Stents; Stents - adverse effects; Surgery; Time factor; Treatment Outcome
• ISSN: 0960-7404; 1879-3320
• DOI: 10.1016/j.suronc.2023.101918

To evaluate the operative and oncological results after colonic stent bridging for left-sided malignant large bowel intestinal obstruction and the risk factors for survival and recurrence after definitive surgery. Consecutive patients who underwent colonic stenting for malignant left-sided colonic obstruction were included. Patients for palliative stenting or emergency surgery, patient with low rectal tumour or peritoneal metastasis were excluded. The primary outcome was overall survival. Secondary outcomes included stent success rate, stenting related complications, rate of stoma formation and long-term oncological outcome including recurrence rate and recurrence free survival rate. From June 2011 to June 2021, a total of 222 patients underwent colonic stenting. 112 patients were bridged to surgery after initial stenting, but 7 patients dropped out. Overall survival was 35 months (IQR = 17.75–75.25 months) in the early operation group, 30 months (IQR = 17.5–49.5 months) in the delayed surgery group HR 0.981 (95%CI 0.70–1.395, p = 0.907). Sensitivity analysis performed by excluding stent complications and emergency surgery yielded the same conclusion. Overall stenting complications rate was 17.1%. 11 patients (10.4%) required emergency surgery. There was no difference between early and delayed surgery groups (>4weeks) in the overall survival and recurrence in patients who had stent-bridge to surgery for malignant left colonic obstruction. It is safe to defer definitive surgery to optimize patients and allow better recovery from initial obstruction after colonic stenting before definitive surgery without adversely affecting the oncological outcomes. •Timing for definitive surgery after colonic stent bridging is debatable.•Recovery from initial obstruction and optimization of surgery takes around 4 weeks.•No adverse perioperative and oncological outcome in delaying patient in need for optimization before definitive surgery.•Potential window to fit in Prehabilitation before definitive surgery.