Masafumi Tomita, MD, Kouji Yasuda, Nozomi Kashu, Hiroyuki Yoshitake, Tomoya Takami, Koutaro Hatano, Naoki Kataoka, Tomoyuki Yamaguchi, Yoshiharu Shouno, Shinichiro Makimoto. Kishiwada Tokushukai Hospital
Background: Self-expandable metallic stents (SEMS) are widely accepted for treating malignant colorectal obstruction (MCO) in stenting procedures as a bridge to surgery (BTS). Transanal decompression tubes (TDT) for MCO are also used in East Asia, especially in Japan. This study aimed to retrospectively evaluate the safety and efficacy of SEMS and TDT for MCO.
Methods and Procedures: We identified 70 patients who underwent procedures using TDT or SEMS at the Kishiwada Tokushukai Hospital. From January 2009 to December 2011, 36 consecutive patients underwent TDT for MCO. After January 2012 (when the SEMS procedure became covered by the Japanese national health insurance system) to December 2014, 34 patients underwent SEMS for MCO. There was no significant difference in the TNM stages of the two groups. Procedural complications, postoperative complications, and 3-year disease-free survival rates were compared between the two groups. Technical success was defined as accurate SEMS or TDT placement on the first attempt with no adverse events. Clinical success of BTS was defined as decompression and relief of obstructive symptoms until surgery with no stent-related complications or need for endoscopic re-intervention or emergency surgery.
Results: The technical success rate was 91.7% (33/36) in the TDT group and 97.1% (33/34) in the SEMS group. The clinical success rate was 69.7% (23/33) in the TDT group and 97.0% (32/33) in the SEMS group. Procedure-related preoperative complications occurred in 5.6% of TDT and 8.8% in SEMS cases; perforation occurred in 2.8% of cases in the TDT group and 2.9% of cases in the SEMS group. Primary anastomosis was possible in 71.4% of TDT and 93.9% of SEMS cases, 12.0% and 6.5% of whom had anastomosis leakage, respectively. The overall stoma creation rate was 28.6% of TDT and 6.1% of SEMS cases. The postoperative complication rate was 20.0% and 6.1% and mortality rate was 5.6% and 0%, respectively; the 3-year disease-free survival rate was 64.0% and 63.4%, respectively.
Conclusion: SEMS for MCO as BTS was safer and more effective than the TDT procedure. Oncological outcomes were similar for SEMS and TDT. Thus, SEMS procedures may be useful and less burdensome for patients with MCO.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93816
Program Number: P334
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster