Comparison of the Oncological Outcomes of Stenting as a Bridge to Surgery and Surgery Alone in Stages II-III Obstructive Colorectal Cancer; A Retrospective Study

Abstract

Background: The Japanese Society for Cancer of the Colon and Rectum guidelines in 2019, stated that stenting as a bridge to surgery (BTS) for obstructive cancer may cause perforation and other adverse effects, which may worsen the long‑term prognosis. This study aimed to evaluate retrospectively the surgical and oncological outcomes of BTS using a stent compared with surgery alone for obstructive colorectal cancer.Methods: Consecutive patients who underwent curative resection for stages II-III obstructive colorectal cancer at our institution from January 2009 to March 2020, were registered retrospectively and divided into 43 patients in the BTS group and 65 patients in the surgery alone group. We compared the surgical and oncological outcomes between the two groups.Results: Stent-related perforation did not occur in any patient. The patient in whom the stent placement was unsuccessful underwent emergency surgery with poor decompression even after SEMS placement (clinical success rate, 97.4%). The pathological characteristics were not significantly different between the groups. The following surgical outcomes in the BTS group were superior to those in the surgery alone group: non-emergency surgery (P < 0.001), surgical approach (P = 0.006), and length of hospital stay (P = 0.020). The median follow-up time was 44.9 months (range, 1.1 - 126.5 months). The 3-year relapse-free survival rates were 68.4% and 58.2% (P = 0.411), and the overall survival rates were 78.3% and 88.2% (P = 0.255) in the surgery alone and BTS groups, respectively. The 3-year locoregional recurrence rates were 10.2% and 8.0% (P = 0.948), and distant metastatic recurrence rates were 13.3% and 30.4% (P = 0.035) in the surgery alone and BTS groups, respectively. Conclusion: This study revealed that BTS with stent may be associated with a higher frequency of distant metastatic recurrence. Stent for stages II-III obstructive colorectal cancer potentially worsens oncological outcomes.Trial registration: This study was registered retrospectively in University hospital Medical Information Network (UMIN)- Clinical Trials Registry. (Trial registration: UMIN, UMIN000040771. Registered 15 June 2020 - Retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/icdr/ctr_view.cgi?recptno=R000046558).