Self-expandable metallic stenting as a bridge to elective surgery versus emergency surgery for acute malignant right-sided colorectal obstruction

Abstract

Background The use of a self-expandable metallic stent (SEMS) as a bridge to surgery has increased for patients with obstructing colorectal cancer. However, relatively few reports have compared SEMS as a bridge to elective surgery for acute malignant obstruction of the right-sided colon (MORC) vs. emergency surgery (ES). This study aimed to evaluate the benefits of elective surgery after SEMS placement vs. ES for patients (including stage IV cases) with acute MORC. Methods Patients with acute MORC who underwent radical resection for a primary tumour from July 2008 to November 2016 at Zhongshan Hospital of Fudan University were retrospectively enrolled. Postoperative short-term outcomes, progression-free survival (PFS), and overall survival (OS) were compared between the SEMS and ES groups. Results In total, 107 patients with acute MORC (35 in the SEMS group and 72 in the ES group) were included for analysis. The Intensive Care Unit admission rate was lower (11.4% vs. 34.7%, P = 0.011), the incidence of complications was reduced (11.4% vs. 29.2%, P = 0.042), and the postoperative length of hospitalisation was significantly shorter (8.23 ± 6.50 vs. 11.18 ± 6.71 days, P = 0.033) for the SEMS group. Survival curves showed no significant difference in PFS (P = 0.506) or OS (P = 0.989) between groups. Also, there was no significant difference in PFS and OS rates between patients with stage II and III colon cancer. After colectomy for synchronous liver metastases among stage IV patients, the hepatectomy rates for the SEMS and ES groups were 85.7% and 14.3%, respectively (P = 0.029). The hazard ratio for colectomy alone vs. combined resection was 3.258 (95% CI 0.858–12.370; P = 0.041). Conclusion Stent placement offers significant advantages in terms of short-term outcomes and comparable prognoses for acute MORC patients. For synchronous liver metastases, SEMS placement better prepares the patient for resection of the primary tumour and liver metastasis, which contribute to improved survival.

Comparison of Short-term Outcomes of a Self-expandable Metallic Stent as a Bridge to Laparoscopic Surgery between Right- and Left-sided Obstructive Colorectal Cancers: A Retrospective Observational Study

“…Second, certain parameters that evaluate SEMS placement difficulties, such as procedure time, were not compared. Third, this study might have yielded higher complications rates in the right-sided group than in previous studies [15,17]. However, some studies have reported similar complication rates [26,33]; therefore, controversy remains.…”

“…In addition, differences in the success rates of SEMS placement between right-and left-sided OCRCs remain controversial [11][12][13]. Moreover, although a previous systematic review and some retrospective studies have demonstrated satisfactory postoperative outcomes of SEMS use for right-sided OCRC as a BTS compared with emergency surgery [14][15][16], few studies have compared the postoperative short-term outcomes of SEMS use as a BTS between right-and left-sided OCRCs.…”

Laparoscopic Hartmann Procedure—A Surgery That Still Saves Lives

“…In recent years, self-expandable metal stents (SEMS) have been used more and more as a bridge to surgery for patients with obstructive colorectal cancer; they offer significant advantages, and they offer efficacy and safety comparable to HP in the management of malignant rectosigmoid obstruction, especially in people with high ASA risk, or in an advanced tumor stage, with faster recovery and shorter hospitalization time [38][39][40]. The use of SEMSs in the presence of perforation or peritonitis is contraindicated; in these conditions, a Hartmann resection is preferred [41].…”

An Unusual Complication of Self-Expandable Metal Stent Placement in Malignant Sigmoid Obstruction

“…Approximately 8–13% of patients with advanced colon cancer present with an obstruction of the large bowel, and the left side colon is the most common site of obstruction [ 1 ]. Acute colorectal obstruction is a medical emergency that necessitates immediate management.…”