Impact on surgical and oncological results of the use of colonic stents as a bridge to surgery for potentially curable occlusive colorectal neoplasms

Abstract

Introduction: The outcomes of patients treated with colonic stents as a bridge to surgery (BTS) have recently been questioned in terms of safety and long-term oncologic outcomes. The aim of this study is to evaluate the effects on surgical and oncologic outcomes of colonic stents as a BTS for potentially resectable obstructive colorectal cancer.

Methods: We conducted a retrospective analysis of patients operated on for potentially resectable obstructive colorectal cancer with or without distant disease between September 2002 and October 2015, comparing the patients treated with a colonic stent as a BTS (Stent group) with those directly operated on (Surgery group).

Results: Twenty patients underwent urgent surgery, while stent placement as a BTS was attempted in 57 patients. The Stent group had more patients treated with a laparoscopic approach (64.9 vs. 5%, P<.001), higher primary anastomosis rate (91.2 vs. 55%, P=.001), less need for stomata (10.5 vs. 50%, P=.001) and shorter postoperative hospital stay (7 vs. 12 days, P=.014). Thirty-day morbidity was reduced in the Stent group, although not significantly (29.8 vs. 50%, P=.104). However, 30-day mortality was significantly lower (1.8 vs. 20%, P=.015). Regarding the long-term oncologic outcomes, no significant differences were found when comparing overall survival, disease-free survival, local recurrence-free survival, distant recurrence-free survival or progression-free survival.

Conclusions: Colonic stenting as a BTS for potentially resectable obstructive colorectal cancer seems to offer better surgical and equal long-term oncologic outcomes when compared to those of patients directly operated on.

Keywords: Colonic stents; Colorectal neoplasms; Estudios de seguimiento; Follow-up studies; Laparoscopia; Laparoscopy; Neoplasias colorrectales; Resultados; Stents cólicos; Treatment outcome.