The Long-term Outcomes of Endoscopic Stenting as a Bridge to Elective Surgery in Patients with Colorectal Cancer Obstruction as Compared with Emergency Surgery

PURPOSE: The aim of this study was to compare the short- and long-term outcomes between stent placement as a bridge to surgery and emergency surgery for obstructive colon cancer. METHODS: Patients who underwent surgery for left colon cancer and rectal cancer with total obstruction from September 2006 to October 2014 were enrolled. Data for the stent placement and emergency surgery groups were compared. RESULTS: Of the 67 patients with total obstruction, 53 patients were treated with stent placement and 14 patients were treated with emergency surgery. Significant differences were observed for surgical approach, type of operation, and combined resection. Use of minimally invasive surgery (MIS) was higher (88.6 vs. 42.9%, p<0.001) in the stent placement (SP) group, and combined resection (5.9 vs. 37.5%, p<0.001) was higher in the emergency surgery (EM) group. In the SP group, resection and anastomosis accounted for the largest proportion (92.5%) and in the EM group, Hartmann's procedure was most common (57.1%) (p<0.001). There were no significant differences in other operative outcomes or in postoperative courses. Five-year overall survival was 96.0 and 77.8% (p=0.311) in the SP and EM groups, respectively. Five-year disease-free survival for local recurrence in the SP and EM groups was 90.0 and 88.9% (p=0.904). CONCLUSION: Stent placement as a bridge to surgery can be performed safely and represents an alternative to emergency surgery with good short-term results. Stent placement as a bridge to surgery is also comparable to emergency surgery in long-term outcomes.

Experiencia del Instituto Nacional de Cancerología en el manejo de obstrucción del tracto de salida gástrico y del colon con prótesis metálicas autoexpandibles (PMAE) / Experience of the National Institute of Cancer Research in managing obtruccions of the gastric tract outlet and colon with self expanding metal stents (SEMS)

Objetivo: conocer la experiencia en el uso de prótesis metálicas autoexpandibles para el manejo de las obstrucciones malignas del tracto de salida gástrico o del colon, así como describir las características demográficas, clínicas y patológicas de los pacientes del Instituto Nacional de Cancerología (INC) durante el periodo comprendido entre enero 1 de 2010 y septiembre 30 de 212. Método: estudio observacional, descriptivo, retrospectivo de serie de casos, que incluyo pacientes con obstrucción del tracto de salida gástrico o colorrectal, donde se analizan las características clínicas y los factores involucrados en el éxito técnico y clínico de la inserción de PMAE, así como la influencia de dichas prótesis en la morbimortalidad. Resultados: se incluyeron 96 pacientes, 73 con PMAE duodenal y 23 con PMAE colorrectal, con edad promedio de 63,7 años. El éxito técnico para la inserción de PMAE duodenal fue del 97,2% y el éxito clínico fue de 93,1%. Para las PMAE colorrectales, el éxito técnico y clínico fueron de 91,3%. Se presentaron 8 complicaciones y 3 pacientes requirieron cirugía para solucionar una complicación. El promedio de vida después del procedimiento fue de 102 días para las PMAE duodenales y 159 días para los colorrectales. No se presento mortalidad secundaria al procedimiento. Conclusiones: la inserción de una PMAE es un procedimiento de mínima invasión que ha demostrado ser un tratamiento paliativo efectivo y una alternativa para reducir la formación de ostomías reduciendo costos y complicaciones.

A Comparison of the Use of Self-Expanding Metallic Stent Insertion with Emergency Surgery as an Initial Treatment for Obstructive Colorectal Cancer / 대한소화기내시경학회지

BACKGROUND/AIMS: Emergency surgery for obstructive colorectal cancer is associated with a high rate of postoperative complications. The objective of this study is to investigate the clinical difference between the use of elective surgery after stent insertion, and the performance of emergency surgery as an initial treatment for colorectal cancer with an intestinal obstruction. METHODS: For patients that were admitted from February 2004 to June 2006 for obstructive colorectal cancer, a retrospective analysis on the clinical outcome was performed for a group of patients that received a stent as an initial treatment (stent group) and a group of patients that received emergency surgery as an initial treatment (emergency operation group). RESULTS: Postoperative complications in the stent group included pneumonia and wound infection (9.5%). For the emergency operation group, postoperative complications included sepsis, deep vein thrombosis, wound infection, anastomosis leakage and postoperative bleeding (38.9%). The number of postoperative complications were significantly less in patients in the stent group than for patients in the emergency operation group (p=0.032). The number of a one-staged operation was significantly higher in the stent group compared with the emergency operation group (85.7% vs 55.6%; p=0.039). The number of a stoma created at least once was significantly lower in the stent group (14.3% vs 50%; p=0.017) than in the emergency operation group. CONCLUSIONS: As an initial treatment for an obstructive colorectal cancer, the use of stent insertion for primary management should be considered since it can reduce the degree of postoperative complications and the necessity for multi-staged operations.