Short-term outcomes of self-expanding metal stent placement as a bridge to surgery for acute colorectal cancer obstruction

Yoshihisa Saida, MD, Toshiyuki Enomoto, MD, Emiko Takeshita, MD, Kazuhiro Takabayashi, MD, Sayaka Nagao, MD, Yoichi Nakamura, MD, Miwa Katagiri, MD, Ryohei Watanabe, MD, Yasushi Nagaoka, MD, Manabu Watanabe, MD, Koji Asai, MD, Natsuya Katada, MD, Shinya Kusachi, MD. Department of Surgery, Toho University Ohashi Medical Center

AIM: The aim of this study was to evaluate the short-term outcomes of self-expanding metal stent (SEMS) insertion as a bridge to surgery (BTS) in patients presenting with acute colorectal cancer obstruction.

METHODS: All patients with acute colorectal cancer obstruction who underwent endoscopic SEMS placement with a guide wire under radiographic guidance and utilizing colonoscopy, as a BTS between 1993 and September 2015 were reviewed and included in the study.

RESULTS: A total of 215 patients underwent EMS placement for colorectal stenosis during the period, those included 147 BTS, 60 palliative purpose cases for unresectable malignant diseases and 8 benign strictures.

In 147 BTS cases, 88M and 59F; mean age 67 were included.

The BTS was able to be successfully performed in 137 cases (successful rate: 93%). Complications at the time of insertion were; 4 perforation cases in sigmoid colon and rectosigmoid (3%) and 4 migration in Transverse, descending, sigmoid colon and rectum (3%). The surgery enabled 99% of total case to EMS insertion of bridge to surgery. The duration of preoperative EMS placement was 3-27 days (mean: 8days). No intraoperative mortality and morbidity, or postoperative mortality were observed. Postoperative morbidities included 4 wound infection, 2 ileus, 1 abdominal abscess and 3 leakages. These results are considered to be relatively favorable. The rate of stoma creation after BTS was 7%, which is lower than the rate of 67% from the cases that EMS could not be placed. Circumferentially obstructive colorectal cancer often gives us difficult preoperative treatment, risk of contaminated operation and the need for secondary operation. But EMS enables us to obtain wider lumen to decrease the pressure of proximal intestine. It also enables us to inspect proximal intestine and to perform elective surgery after preoperative mechanical preparation. So, SEMS for BTS has been effectively used.

CONCLUSIONS: In our experience, SEMS placement as a BTS is a safe and effective strategy for the treatment of patients with acute colorectal cancer obstruction.

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