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

ABSTRACT

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.