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Colonic stent-induced mechanical compression may suppress cancer cell proliferation in malignant large bowel obstruction

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Abstract

Background

The short-term safety and efficacy of insertion of a self-expandable metallic colonic stent (SEMS) followed by elective surgery, “bridge to surgery (BTS)”, for malignant large bowel obstruction (MLBO) have been well described; however, the influence on long-term oncological outcomes is unclear. The aim of this study was to evaluate changes in oncological characteristics in colorectal cancer (CRC) tissues after SEMS insertion, focusing on growth factors, cell cycle and apoptosis.

Methods

From January 2013 to September 2014, a total of 25 patients with MLBO who underwent BTS at our single institution were retrospectively included. Paired CRC tissue samples before (endoscopic biopsy) and after SEMS insertion (surgically resected) were collected from each patient. EGFR, VEGF, Ki-67, p27kip1 and TUNEL expression were determined by immunohistochemistry.

Results

No clinical or subclinical perforations evaluated by mechanical ulceration pathologically were observed. Epithelial exfoliation, tumour necrosis, infiltration of inflammatory cells and fibrosis were observed in SEMS-inserted surgically-resected specimens. Overall, 84% (21/25) and 60% (15/25) of patients exhibited no change or a decrease in staining category, respectively, for EGFR and VEGF expression after SEMS insertion. A significant decrease in Ki-67 expression was observed in surgically-resected specimens compared with endoscopic biopsy specimens (P < 0.01). The upstream cell cycle inhibitor, p27kip1, was significantly increased after SEMS insertion (P = 0.049).

Conclusions

Although the long-term safety of BTS should be determined in a future clinical trial, mechanical compression by SEMS may suppress cancer cell proliferation and this result could provide some insights into the issue.

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Acknowledgements

We thank H. Nikki March, PhD, from Edanz Group (http://www.edanzediting.com/ac) for editing a draft of this manuscript.

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Authors and Affiliations

  1. Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan

    Akihisa Matsuda, Masao Miyashita, Satoshi Matsumoto, Nobuyuki Sakurazawa, Youichi Kawano, Kazuya Yamahatsu, Kumiko Sekiguchi & Marina Yamada

  2. Department of Pathology, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan

    Tsutomu Hatori

  3. Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan

    Hiroshi Yoshida

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  1. Akihisa Matsuda
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  2. Masao Miyashita
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Contributions

Study concept and design: AM and SM. Acquisition of data: AM, NS, YK, KY, KS, MY, and TH. Analysis and interpretation of data: AM, and SM. Drafting of the manuscript: AM. Study supervision: MM, and HY.

Corresponding author

Correspondence to Akihisa Matsuda.

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Drs. Akihisa Matsuda, Masao Miyashita, Satoshi Matsumoto, Nobuyuki Sakurazawa, Youichi Kawano, Kazuya Yamahatsu, Kumiko Sekiguchi, Marina Yamada, Tsutomu Hatori, and Hiroshi Yoshida have no conflicts of interest or financial ties to disclose.

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Matsuda, A., Miyashita, M., Matsumoto, S. et al. Colonic stent-induced mechanical compression may suppress cancer cell proliferation in malignant large bowel obstruction. Surg Endosc 33, 1290–1297 (2019). https://doi.org/10.1007/s00464-018-6411-x

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