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Effect of self-expandable metal stent on morbidity and mortality and oncological prognosis in malignant colonic obstruction: retrospective analysis of its use as curative and palliative treatment

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Abstract

Introduction

Acute gastrointestinal obstruction due to colorectal cancer occurs in 7–30% of cases and is an abdominal emergency that requires urgent decompression. The safety and oncological effect of self-expandable metal stents (SEMS) in these patients remains controversial. This study aimed to evaluate its impact on these variables and compare it with that of emergency surgery (ES).

Methods

Descriptive, retrospective and single-centre study, performed between 2008 and 2015, with follow-up until 2017. One hundred eleven patients with diagnosis of left malignant colonic obstruction were included and divided according to the treatment received: stent as bridge to surgery (SBTS group: 39), palliative stent (PS group: 30) and emergency surgery with curative (ECS group: 34) or palliative intent (EPS group: 8). Treatment was decided by the attending surgeon in charge.

Results

Technical and clinical general success rates for colorectal SEMS were 95.7% and 91.3%, respectively, with an associated morbimortality of 23.2%, which was higher in the PS group (p = 0.002). The SBTS group presented a higher laparoscopic approach and primary anastomosis (p < 0.001), as well as a lower colostomy rate than the ECS group (12.8% vs. 40%; p = 0.023). Postoperative morbidity and mortality were significantly lower in the SBTS group compared to the ECS group (41% vs. 67.6%; p = 0.025). Overall survival (OS) and disease-free survival (DFS) were similar between the analysed groups.

Conclusion

Colonic stent placement is a safe and effective therapeutic alternative to emergency surgery in the management of left-sided malignant colonic obstruction in both curative and palliative fields. It presents a lower postoperative morbimortality and a similar oncological prognosis.

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Authors and Affiliations

  1. Department of General and Digestive Surgery, Hospital Universitario Nuestra Señora del Prado, Talavera de la Reina, Spain

    Carlos Bustamante Recuenco

  2. Department of General and Digestive Surgery, Hospital Universitario La Princesa, Madrid, Spain

    Javier García Septiem

  3. Faculty of Medicine, General Surgery, Universidad Complutense de Madrid, Madrid, Spain

    Javier Arias Díaz

  4. Universidad Europea de Madrid, Madrid, Spain

    Israel John Thuissard Vasallo

  5. Department of General and Digestive Surgery, Hospital Universitario de Salamanca, Salamanca, Spain

    Alejandro Andonaegui de la Madriz

  6. Department of General and Digestive Surgery, Hospital Universitario de Getafe, Madrid, Spain

    Virginia Jiménez Carneros & Francisco Javier Jiménez Miramón

  7. Department of General and Digestive Surgery, Hospital Universitario de Getafe, Madrid, Spain

    Jose Luis Ramos Rodríguez

  8. Department of General and Digestive Surgery, Hospital Universitario de Getafe, Madrid, Spain

    José María Jover Navalón

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  1. Carlos Bustamante Recuenco
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Recuenco, C.B., Septiem, J.G., Díaz, J.A. et al. Effect of self-expandable metal stent on morbidity and mortality and oncological prognosis in malignant colonic obstruction: retrospective analysis of its use as curative and palliative treatment. Int J Colorectal Dis 37, 475–484 (2022). https://doi.org/10.1007/s00384-021-04081-8

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