Stenting as a Bridge to Surgery for Obstructive Colon Cancer: Does It Have Surgical Merit or Oncologic Demerit?

PURPOSE

To evaluate the surgical and oncologic outcomes of patients undergoing self-expandable metallic stent (SEMS) placement with elective curative surgery.

METHODS

Data from patients admitted with obstructing colon cancer between 2000 and 2012 were analyzed retrospectively. Patients underwent either SEMS placement as a bridge to surgery (stent group, n = 67) or emergency surgery (surgery group, n = 35). Surgical and oncologic outcomes of the groups were compared.

RESULTS

Placement of SEMS was technically successful in 98.5% and clinically successful in 89.6% of cases. There were eight (11.9%) stent-related complications, including three migrations (4.5%), four occlusions (6.0%), and one perforation (1.5%). The stent group had a higher laparoscopic resection rate (67.2 vs. 31.4%, p = 0.001) with a lower conversion rate (4.3 vs. 35.3%, p = 0.003). The wound infection rate was significantly higher in the surgery group (37.1 vs. 11.9%, p = 0.003) with no differences in the rate of other complications. The rates of local recurrence and distant metastasis, recurrence-free, and overall survival were not significantly different between the two groups.

CONCLUSIONS

Stenting and elective surgery was associated with a higher laparoscopy rate, a lower conversion rate, and a lower wound infection rate compared to emergency surgery but did not affect recurrence or survival.