Safety and feasibility of neoadjuvant chemotherapy as a surgical bridge for acute left-sided malignant colorectal obstruction : a retrospective study

Abstract

Background: For colorectal cancer, preoperative (neoadjuvant) chemotherapy is more effective than postoperative chemotherapy because it eradicates micrometastases more effectively and reduces the risk of incomplete intraoperative resection and tumor cell shedding. For the treatment of acute left-sided malignant colorectal obstruction, colorectal stents as well as stoma are being used to relieve the obstructive colorectal cancer, and as a bridge to surgery, allowing easy mobilization and resection of the colon. Neoadjuvant chemotherapy combined with self-expanding metal stents or neoadjuvant chemotherapy combined with stoma can be used as a bridge to elective surgery as an alternative to emergency surgery in patients with acute left-sided malignant colorectal obstruction, but its benefit is uncertain. The purpose of this study was to evaluate the safety and feasibility of neoadjuvant chemotherapy as a bridge to surgery in the treatment of acute left-sided malignant colorectal obstruction.Methods: Data from patients who were admitted withacute left-sided malignant colorectal obstruction between January 2012 and December 2020 were retrospectively reviewed；Patients with peritonitis or bowel perforation were excluded. We performed one-to-two propensity score matching to compare the stoma requirement, postoperative complications, and other short-term oncological outcomes between the neoadjuvant chemotherapy group and surgery groups.Results: There were no differences in intraoperative blood loss, operative time,one-year postoperative mortality, and postoperative tumor markers between the two groups. The 1-year recurrence-free survival (RFS) rates of the surgery group and neoadjuvant chemotherapy group were 91.3% and 96.8%(p=0.562).The neoadjuvant chemotherapy group was able to reduce stoma rate one year after surgery(p =0.047).Besides,the neoadjuvant group significantly reduced postoperative bowel function time (p <0.001), postoperative hospital stay (p <0.001), total hospital stay (p = 0.002), postoperative complications (p = 0.017),and fewer access to intensive care unit treatment(p = 0.042).Conclusions: The use of neoadjuvant chemotherapy as a bridge to elective surgery in patients with acute left-sided malignant colorectal obstruction has many advantages, including faster recovery bowel function, enables early closure of the colostomy,reduce the incidence of postoperative complications, fewer transitions to intensive care unit or treatment,and reduce postoperative hospital stay. Neoadjuvant chemotherapy as a bridge to elective surgery for acute left-sided malignant colorectal obstruction is safe and feasible.