World Journal of Surgery

, 33:1281 | Cite as

Oncologic Outcomes of Self-Expanding Metallic Stent Insertion as a Bridge to Surgery in the Management of Left-Sided Colon Cancer Obstruction: Comparison with Nonobstructing Elective Surgery

  • Jin Soo Kim
  • Hyuk Hur
  • Byung Soh Min
  • Seung Kook Sohn
  • Chang Hwan Cho
  • Nam Kyu Kim



Self-expanding metallic stents (SEMS) have been used as a bridge to surgery in patients with obstruction by colorectal cancer, but the oncologic safety of this technique has not yet been established. The aim of the present study was to compare the outcomes of bridge to surgery after SEMS insertion and nonobstructing elective surgery.


Between October 1999 and July 2007, 35 patients who had left-sided colon malignancy obstruction and underwent surgical resection after SEMS insertion (group A) were matched to 350 patients who underwent elective surgery for nonobstructing left-sided colon cancer based on stage II, III, and IV malignancies according to the 2001 American Joint Committee on Cancer (group B). Group B was randomly extracted from the colorectal database of our institute. The two groups were compared for clinicopathologic variables, complications, and survival rate.


There were no significant differences in clinicopathologic variables between group A and group B. However, the stoma formation rate was statistically different between the two groups (p = 0.003). Self-expanding metallic stent insertion had an adverse effect on the 5-year overall survival rate (A vs. B, 38.4% vs. 65.6%, respectively; p = 0.025) and the 5-year disease-free survival rate (A vs. B, 48.3% vs. 75.5%, respectively; p = 0.024).


These data show that insertion of SEMS as a bridge to surgery in the management of left-sided colon cancer obstruction is possibly associated with adverse oncologic outcomes compared with nonobstructing elective surgery, but it is unclear what magnitude of this effect is related to the underlying obstruction rather than to the SEMS.


Oncologic Outcome Stent Insertion Stent Group Colonic Obstruction SEMS Placement 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This work was supported by a grant from the Korea Health 21 R&D Project, Ministry of Health and Welfare, Republic of Korea (0412-CR01-0704-0001, 0405-BC01-0604-0002).


  1. 1.
    Coleman MP, Esteve J, Damiecki P et al (1993) Trends in cancer incidence and mortality. IARC Sci Pub No. 121, 806 ppGoogle Scholar
  2. 2.
    Dauphine CE, Tan P, Beart RW Jr et al (2002) Placement of self-expanding metal stents for acute malignant large-bowel obstruction: a collective review. Ann Surg Oncol 9:574–579PubMedCrossRefGoogle Scholar
  3. 3.
    Deans GT, Krukowski ZH, Irwin ST (1994) Malignant obstruction of the left colon. Br J Surg 81:1270–1276PubMedCrossRefGoogle Scholar
  4. 4.
    Barillari P, Aurello P, De Angelis R et al (1992) Management and survival of patients affected with obstructive colorectal cancer. Int Surg 77:251–255PubMedGoogle Scholar
  5. 5.
    Pearce NW, Scott SD, Karran SJ (1992) Timing and method of reversal of Hartmann’s procedure. Br J Surg 79:839–841PubMedCrossRefGoogle Scholar
  6. 6.
    Martinez-Santos C, Lobato RF, Fradejas JM et al (2002) Self-expandable stent before elective surgery vs. emergency surgery for the treatment of malignant colorectal obstructions: comparison of primary anastomosis and morbidity rates. Dis Colon Rectum 45:401–406PubMedCrossRefGoogle Scholar
  7. 7.
    Sebastian S, Johnston S, Geoghegan T et al (2004) Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol 99:2051–2057PubMedCrossRefGoogle Scholar
  8. 8.
    Meisner S, Hensler M, Knop FK et al (2004) Self-expanding metal stents for colonic obstruction: experiences from 104 procedures in a single center. Dis Colon Rectum 47:444–450PubMedCrossRefGoogle Scholar
  9. 9.
    Khot UP, Lang AW, Murali K et al (2002) Systematic review of the efficacy and safety of colorectal stents. Br J Surg 89:1096–1102PubMedCrossRefGoogle Scholar
  10. 10.
    McArdle CS, McMillan DC, Hole DJ (2006) The impact of blood loss, obstruction and perforation on survival in patients undergoing curative resection for colon cancer. Br J Surg 93:483–488PubMedCrossRefGoogle Scholar
  11. 11.
    Slanetz CA Jr (1984) The effect of inadvertent intraoperative perforation on survival and recurrence in colorectal cancer. Dis Colon Rectum 27:792–797PubMedCrossRefGoogle Scholar
  12. 12.
    Maruthachalam K, Lash GE, Shenton BK et al (2007) Tumour cell dissemination following endoscopic stent insertion. Br J Surg 94:1151–1154PubMedCrossRefGoogle Scholar
  13. 13.
    Baron TH (2005) Colonic stenting: technique, technology, and outcomes for malignant and benign disease. Gastrointest Endosc Clin North Am 15:757–771CrossRefGoogle Scholar
  14. 14.
    Watt AM, Faragher IG, Griffin TT et al (2007) Self-expanding metallic stents for relieving malignant colorectal obstruction: a systematic review. Ann Surg 246:24–30PubMedCrossRefGoogle Scholar
  15. 15.
    Choo IW, Do YS, Suh SW et al (1998) Malignant colorectal obstruction: treatment with a flexible covered stent. Radiology 206:415–421PubMedGoogle Scholar
  16. 16.
    Law WL, Chu KW, Ho JW et al (2000) Self-expanding metallic stent in the treatment of colonic obstruction caused by advanced malignancies. Dis Colon Rectum 43:1522–1527PubMedCrossRefGoogle Scholar
  17. 17.
    Tominaga K, Yoshida M, Maetani I et al (2001) Expandable metal stent placement in the treatment of a malignant anastomotic stricture of the transverse colon. Gastrointest Endosc 53:524–527PubMedCrossRefGoogle Scholar
  18. 18.
    Lee KM, Shin SJ, Hwang JC et al (2007) Comparison of uncovered stent with covered stent for treatment of malignant colorectal obstruction. Gastrointest Endosc 66:931–936PubMedCrossRefGoogle Scholar
  19. 19.
    Baron TH (2004) Indications and results of endoscopic rectal stenting. J Gastrointest Surg 8:266–269PubMedCrossRefGoogle Scholar
  20. 20.
    Law WL, Choi HK, Chu KW (2003) Comparison of stenting with emergency surgery as palliative treatment for obstructing primary left-sided colorectal cancer. Br J Surg 90:1429–1433PubMedCrossRefGoogle Scholar
  21. 21.
    Saida Y, Sumiyama Y, Nagao J et al (2003) Long-term prognosis of preoperative “bridge to surgery” expandable metallic stent insertion for obstructive colorectal cancer: comparison with emergency operation. Dis Colon Rectum 46:S44–S49PubMedGoogle Scholar
  22. 22.
    Carne PW, Frye JN, Robertson GM et al (2004) Stents or open operation for palliation of colorectal cancer: a retrospective, cohort study of perioperative outcome and long-term survival. Dis Colon Rectum 47:1455–1461PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2009

Authors and Affiliations

  • Jin Soo Kim
    • 1
  • Hyuk Hur
    • 1
  • Byung Soh Min
    • 1
  • Seung Kook Sohn
    • 1
  • Chang Hwan Cho
    • 1
  • Nam Kyu Kim
    • 1
  1. 1.Department of SurgeryYonsei University College of MedicineSeoulKorea

Personalised recommendations