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Better recurrence-free survival after stent bridge to surgery compared to emergency surgery for obstructive left-sided colonic cancer in patients with stage III status of the American Joint Committee on Cancer (AJCC): a bicentric retrospective study

International Journal of Colorectal Disease volume 34, pages 1241–1250 (2019)Cite this article

Abstract

Purpose

Stenting as a bridge to surgery (SBTS) can transform an emergency surgery (ES) into an elective surgery in patients with symptomatic left-sided malignant colonic obstruction. Concerns have been raised regarding short-term morbidity and long-term oncologic outcomes, with contrasting results reported in the literature. Our main aim is to evaluate not only long-term oncologic outcomes but also short-term postoperative outcomes of stented patients who underwent elective surgery compared to those who had ES.

Methods

From January 2006 to May 2012, we retrospectively identified patients with confirmed left-sided colorectal cancer obstruction. This was done in two centers of reference of colorectal diseases in southern Spain with patients who were treated with curative intent either with ES or SBTS. The short- and long-term results were compared between both groups.

Results

There were 71 patients in the stenting group and 66 in the emergency surgery group, with similar demographic data. Initial stoma creation rates were lower in the SBTS group (16.9% vs. 54.5%, p < 0.005) and the primary anastomosis rate was higher in the same group (83.1% vs. 45.5%, p < 0.005). Five-year recurrence-free survival (RFS) rates were comparable between groups (75.3 vs. 59.8%, p = 0.220), but RFS rates at 5 years for AJCC pathologic stage III were higher in the stenting group (69.7% vs 30%, p = 0.004). Both groups were comparable regarding overall and cancer-specific survival outcomes.

Conclusions

The use of SBTS reduces ostomy rates in patients with obstructive colon malignancies. Long-term survival results are similar. Patients in the SBTS group with stage III AJCC status showed a higher 5-year recurrence-free survival rate than those in the ES group.

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Author information

Affiliations

  1. Department of Digestive Diseases, Virgen de la Victoria University Hospital, Málaga, Spain

    Carmen Lara-Romero, Isabel Lavín-Castejón, Raúl Andrade-Bellido & Guillermo Alcaín-Martínez

  2. Department of Digestive Diseases, Virgen Macarena University Hospital, Seville, Spain

    Carmen Lara-Romero, Ángel Caunedo-Álvarez & Pedro Hergueta-Delgado

  3. Department of Epidemiology and Statistics, Seville University, Seville, Spain

    Ángel Vilches

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  1. Carmen Lara-Romero
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  2. Ángel Vilches
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Correspondence to Carmen Lara-Romero.

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Lara-Romero, C., Vilches, Á., Caunedo-Álvarez, Á. et al. Better recurrence-free survival after stent bridge to surgery compared to emergency surgery for obstructive left-sided colonic cancer in patients with stage III status of the American Joint Committee on Cancer (AJCC): a bicentric retrospective study. Int J Colorectal Dis 34, 1241–1250 (2019). https://doi.org/10.1007/s00384-019-03318-x

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Keywords

  • Colonic stenting
  • Bridge to surgery
  • Malignant left-sided colonic obstruction