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A multicenter case–control study of self-expanding metallic stent versus trans-anal colorectal tube for stage II/III non-right-sided obstructive colon cancer

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Abstract

Background

Self-expanding metallic stent (SEMS) and trans-anal colorectal tube (TCT) are alternative treatments to conventional emergency surgery for non-right-sided obstructive colon cancer (NROCC). However, the one with better short- and long-term outcomes remains controversial. Thus, this multicenter case–control study aimed to analyze and compare SEMS and TCT for NROCC.

Methods

Patients with stage II/III NROCC who underwent surgery between January 2010 and December 2019 at either of the eight selected Japanese affiliate hospitals were, retrospectively, reviewed. Baseline characteristics between the SEMS and TCT groups were adjusted by propensity score (PS) matching.

Results

Among 239 reviewed patients (SEMS: 76, TCT: 163), 180 were finally included in two well-balanced cohorts through PS: SEMS group (65 patients) and TCT group (115 patients). Technical success, clinical success, morbidity, and short-term mortality were not significantly different between the two groups. SEMS placement achieved significantly higher rates for primary resection/anastomosis without stoma (SEMS: 90.8% vs. TCT: 77.4%, p < 0.001) and laparoscopic surgery (SEMS: 64.6% vs. TCT: 43.5%, p < 0.001) than TCT placement. However, 5-year overall survival (SEMS: 83.7% vs. TCT: 86.4%; p = 0.822) and 5-year relapse-free survival (SEMS: 64.7% vs. TCT: 66.4%; p = 0.854) showed no significant differences between these groups.

Conclusions

Both SEMS and TCT revealed similar long-term outcomes, but SEMS placement was better in achieving primary resection/anastomosis and laparoscopic surgery in patients with stage II/III NROCC.

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Funding

The authors received no specific funding for this work.

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Authors and Affiliations

  1. Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, 467-8601, Japan

    Yusuke Okuda, Takaya Shimura, Naomi Sugimura, Shigeki Fukusada, Hiroyasu Iwasaki, Takahito Katano & Hiromi Kataoka

  2. Department of Gastroenterology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myoken-Cho, Showa-Ku, Nagoya, 466-8650, Japan

    Konomu Uno & Tomonori Yamada

  3. Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, 5-161 Maehata, Tajimi, 507-8522, Japan

    Takayuki Nukui & Takashi Mizushima

  4. Department of Gastroenterology, Nagoya City University East Medical Center, 1-2-23 Wakamizu, Chikusa-Ku, Nagoya, 464-8547, Japan

    Yuya Takenaka & Keisuke Itoh

  5. Department of Gastroenterology, Toyokawa City Hospital, 23 Noji, Yahata, Toyokawa, 442-8561, Japan

    Yuki Inagaki & Takanori Ozeki

  6. Department of Gastroenterology, Aichi Medical University, 1-1 Karimata, Iwasaku, Nagakute, 480-1195, Japan

    Kazuhiro Nagao & Masahide Ebi

  7. Department of Gastroenterology, Nagoya City University West Medical Center, 1-1-1 Hirate, Kita-Ku, Nagoya, 462-8508, Japan

    Erika Uchida & Satoshi Nomura

  8. Department of Gastroenterology, Nagoya Memorial Hospital, 4-305 Hirabari, Tenpaku-Ku, Nagoya, 468-8520, Japan

    Yu Nojiri & Shozo Togawa

Authors
  1. Yusuke Okuda
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  2. Takaya Shimura
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Contributions

Conceptualization: TS. Acquisition of data: YO, KU, TN, YT, YI, KN, EU, YN, NS, SF, HI, TK. Analysis and interpretation of data: YO, TS. Writing—original draft preparation: YO. Writing—review and editing: TS. Statistical analysis: YO, TS. Administrative support: TS, TY, TM, KI, TO, ME, SN, ST. Supervision: HK.

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Correspondence to Takaya Shimura.

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Okuda, Y., Shimura, T., Uno, K. et al. A multicenter case–control study of self-expanding metallic stent versus trans-anal colorectal tube for stage II/III non-right-sided obstructive colon cancer. J Gastroenterol 58, 217–228 (2023). https://doi.org/10.1007/s00535-022-01952-x

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