Outcomes of surgery with colonic stents for obstructive colon cancer

Yu Sato, MD, PhD, Yoshimasa Gohda, MD, Tomoko Horie, MD, Tsuyoshi Takaya, MD, Ryuichiro Suda, MD, Yasutaka Syuno, MD, PhD, Hideaki Yano, MD, PhD. Department of Colorectal Surgery, National Center for Global Health and Medicine

Objective: This study is aimed at evaluating the outcomes of colonic stents used as a bridge to surgery in the management of obstructive colorectal cancer.

Methods: We retrospectively identified nine consecutive patients who underwent colonic self-expanding metallic stents (SEMSs) as a bridge to surgery in the management of malignant colonic obstruction in our institution from July 2012 to December 2013. The main outcome measures were the technical success rate, short-term results of surgery, recurrence and overall survival.

Results: All patients had obstructive tumor in the left colon. Of these patients, 55.6% had localized colon cancer without metastasis. Procedural success was 77.8% (7/9). Clinical success was 66.7% (6/9). Elective surgery was performed in 8 patients (7 laparoscopic, 1 open, 1 converted) and 1 emergency surgery in 1 patients for treatment of stent occlusion due to growth of tumor (1 stoma). Median time between stent placement and surgery was 9 days (range 6-15). The postoperative complication rate was 22.2% (2/9). The median postoperative hospital stay was 11 days (range 7-49). The recurrence rate was 50% and mean time to recurrence was 13 months. Median survival was 27 months (range 13-37).

Conclusions: SEMSs provide an effective bridge to surgery treatment in patients with malignant colonic obstruction, allowing elective surgery with an acceptable complication rate. However, our results suggest long-term outcomes of patients with a bridge to surgery might be worse.

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