Kazuki Ueda, MD, Junichiro Kawamura, MD, Koji Daito, MD, Hokuto Ushijima, MD, Tadao Tokoro, MD, Jin-ichi Hida, MD, Haruhiko Imamoto, MD, Kiyotaka Okuno, MD. Kindai University Faculty of Medicine
Introduction: Endoscopic stenting with a self-expandable metallic stent (SEMS) is widely accepted procedure for malignant colorectal obstruction. We assessed the safety and efficacy of insertion of a SEMS followed by elective surgery as ‘Bridge to Surgery (BTS)’ in our institute.
Methods: This study was a retrospective study in our institute. The data was collected from medical charts from January 2014 to June 2017.
Results: A total of 408 consecutive patients underwent radical surgery for colorectal malignancy during this period. In this series, 16 patients (3.9%) were diagnosed malignant colorectal obstruction and intended to a BTS. The stent was successfully placed in 13 patients and all the patients were planned to undergo radical surgery. The failed 3 patients underwent stoma creation (2patients) and Hartmann’s procedure. The technical success rate was 81% and the clinical success rate was 100%. The median time from SEMS to surgery was 11 days (2-31days). Open and laparoscopic surgery was performed in 4 and 8 patients, respectively, except for one patient refused radical surgery because of a great age. The tumor could be resected in 12 patients (BTS patients) with primary anastomosis. However, diverting stoma creation was needed in 3 patients and decompression rectal tube was placed in 1 patient. The entire patient laparoscopically was no conversion to open surgery. There was no anastomotic leakage in BTS patients. The median duration of postoperative hospital stay was 10 days (8-54days). The overall postoperative complication was 23% (3/13) including 2 bowel obstruction and 1 anastomotic stricture. The median follow-up period was 580days. During the follow-up period, 3 patients were relapsed peritoneal dissemination, ovarian metastasis, and liver and pulmonary metastases, respectively. Former 2 patients were diagnosed Stage Iva at the time of primary surgery. One patient died from sudden death.
Conclusions: Our data suggested that routine use of SEMS insertion was safe and effective procedure for malignant colorectal obstruction as a BTS. Moreover, laparoscopic procedure was useful procedure in BTS patient. The short- and long-term surgical outcomes were also acceptable.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86211
Program Number: P212
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster