Although self-expandable metal stents (SEMS) are widely used as a bridge to surgery (BTS) in patients with malignant colorectal cancer obstruction, there has been some debate about their effect on long-term oncological outcomes. Furthermore, data on the safety and feasibility of minimally invasive surgery (MIS) combined with stent placement are scarce. We aimed to determine the long-term oncological outcomes of SEMS as a BTS, and the short-term outcomes of SEMS used with minimally invasive colorectal surgery.
Data from patients who were admitted with malignant obstructing colon cancer between January 2006 and December 2015 were retrospectively reviewed; 71 patients underwent direct surgery and 182 patients underwent SEMS placement as a BTS. Long-term and short-term outcomes of the groups were compared. In a subgroup analysis of the BTS group, the short-term outcomes of conventional open surgery and MIS were compared.
There were no differences in long-term oncologic outcomes between groups. The primary anastomosis rate was higher in the stent group than in the direct surgery group. In the stent group, postoperative complication rates were lower in the minimally invasive group than in the open surgery group. Time to flatus and time to soft diet resumption were shorter in the minimally invasive group, as was length of hospital stay.
Elective surgery after stent insertion does not adversely affect long-term oncologic outcomes. Furthermore, MIS combined with stent insertion for malignant colonic obstruction is safe and feasible.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
McArdle CS, McMillan DC, Hole DJ. The impact of blood loss, obstruction and perforation on survival in patients undergoing curative resection for colon cancer. Br J Surg. 2006;93:483–88.
Cheynel N, Cortet M, Lepage C, Benoit L, Faivre J, Bouvier AM. Trends in frequency and management of obstructing colorectal cancers in a well-defined population. Dis Colon Rectum. 2007;50:1568–75.
Saida Y, Sumiyama Y, Nagao J, Uramatsu M. Long-term prognosis of preoperative “bridge to surgery” expandable metallic stent insertion for obstructive colorectal cancer: comparison with emergency operation. Dis Colon Rectum. 2003;46:S44–9.
Small AJ, Baron TH. Comparison of Wallstent and Ultraflex stents for palliation of malignant left-sided colon obstruction: a retrospective, case-matched analysis. Gastrointest Endosc. 2008;67:478–88.
Harris GJ, Senagore AJ, Lavery IC, Fazio VW. The management of neoplastic colorectal obstruction with colonic endolumenal stenting devices. Am J Surg. 2001;181:499–06.
Sebastian S, Johnston S, Geoghegan T, Torreggiani W, Buckley M. Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol. 2004;99:2051–057.
Cheung HY, Chung CC, Tsang WW, Wong JC, Yau KK, Li MK. Endolaparoscopic approach vs conventional open surgery in the treatment of obstructing left-sided colon cancer: a randomized controlled trial. Arch Surg. 2009;144:1127–132.
Maruthachalam K, Lash GE, Shenton BK, Horgan AF. Tumour cell dissemination following endoscopic stent insertion. Br J Surg. 2007;94:1151–154.
Alcantara M, Serra-Aracil X, Falco J, Mora L, Bombardo J, Navarro S. Prospective, controlled, randomized study of intraoperative colonic lavage versus stent placement in obstructive left-sided colonic cancer. World J Surg. 2011;35:1904–910.
Arezzo A, Balague C, Targarona E, et al. Colonic stenting as a bridge to surgery versus emergency surgery for malignant colonic obstruction: results of a multicentre randomised controlled trial (ESCO trial). Surg Endosc. 2017;31(8):3297–305.
van Hooft JE, Bemelman WA, Oldenburg B, et al. Colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a multicentre randomised trial. Lancet Oncol. 2011;12:344–52.
Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc. 1991;1:144–50.
Jayne DG, Guillou PJ, Thorpe H, et al. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol. 2007;25:3061–068.
COLOR Study Group. COLOR: a randomized clinical trial comparing laparoscopic and open resection for colon cancer. Dig Surg. 2000;17:617–22.
Fleshman J, Sargent DJ, Green E, et al. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg. 2007;246:655–62 (discussion 62-4).
Baron TH, Rey JF, Spinelli P. Expandable metal stent placement for malignant colorectal obstruction. Endoscopy. 2002;34:823–30.
van Hooft JE, van Halsema EE, Vanbiervliet G, et al. Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2014;46:990–1053.
Arezzo A, Balague C, Targarona E, et al. Colonic stenting as a bridge to surgery versus emergency surgery for malignant colonic obstruction: results of a multicentre randomised controlled trial (ESCO trial). Surg Endosc. 2017;31:3297–305.
Sabbagh C, Browet F, Diouf M, et al. Is stenting as “a bridge to surgery” an oncologically safe strategy for the management of acute, left-sided, malignant, colonic obstruction? A comparative study with a propensity score analysis. Ann Surg. 2013;258:107–15.
Tung KL, Cheung HY, Ng LW, Chung CC, Li MK. Endo-laparoscopic approach versus conventional open surgery in the treatment of obstructing left-sided colon cancer: long-term follow-up of a randomized trial. Asian J Endosc Surg. 2013;6:78–81.
Small AJ, Coelho-Prabhu N, Baron TH. Endoscopic placement of self-expandable metal stents for malignant colonic obstruction: long-term outcomes and complication factors. Gastrointest Endosc. 2010;71:560–72.
Kim SJ, Kim HW, Park SB, et al. Colonic perforation either during or after stent insertion as a bridge to surgery for malignant colorectal obstruction increases the risk of peritoneal seeding. Surg Endosc. 2015;29:3499–506.
Tan CJ, Dasari BV, Gardiner K. Systematic review and meta-analysis of randomized clinical trials of self-expanding metallic stents as a bridge to surgery versus emergency surgery for malignant left-sided large bowel obstruction. Br J Surg. 2012;99:469–76.
Lacy AM, Garcia-Valdecasas JC, Delgado S, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet. 2002;359:2224–229.
Kim CW, Kim CH, Baik SH. Outcomes of robotic-assisted colorectal surgery compared with laparoscopic and open surgery: a systematic review. J Gastrointest Surg. 2014;18:816–30.
Yang C, Wexner SD, Safar B, et al. Conversion in laparoscopic surgery: does intraoperative complication influence outcome? Surg Endosc. 2009;23:2454–458.
Morino M, Bertello A, Garbarini A, Rozzio G, Repici A. Malignant colonic obstruction managed by endoscopic stent decompression followed by laparoscopic resections. Surg Endosc. 2002;16:1483–487.
Olmi S, Scaini A, Cesana G, Dinelli M, Lomazzi A, Croce E. Acute colonic obstruction: endoscopic stenting and laparoscopic resection. Surg Endosc. 2007;21:2100–1004.
Stipa F, Pigazzi A, Bascone B, et al. Management of obstructive colorectal cancer with endoscopic stenting followed by single-stage surgery: open or laparoscopic resection? Surg Endosc. 2008;22:1477–481.
Rho SY, Bae SU, Baek SJ, et al. Feasibility and safety of laparoscopic resection following stent insertion for obstructing left-sided colon cancer. J Korean Surg Soc. 2013;85:290–95.
Chung TS, Lim SB, Sohn DK, et al. Feasibility of single-stage laparoscopic resection after placement of a self-expandable metallic stent for obstructive left colorectal cancer. World J Surg. 2008;32:2275–280.
Law WL, Poon JT, Fan JK, Lo OS. Colorectal resection after stent insertion for obstructing cancer: comparison between open and laparoscopic approaches. Surg Laparosc Endosc Percutan Tech. 2013;23:29–32.
Park IJ, Choi GS, Kang BM, et al. Comparison of one-stage managements of obstructing left-sided colon and rectal cancer: stent-laparoscopic approach vs. intraoperative colonic lavage. J Gastrointest Surg. 2009;13:960–65.
Cho JH, Lim DR, Hur H, et al. Oncologic outcomes of a laparoscopic right hemicolectomy for colon cancer: results of a 3-year follow-up. J Korean Soc Coloproctol. 2012;28:42–8.
SYY: Data collection and analysis, manuscript writing. YYP: Data collection, critical review. YDH: Data collection, critical review. MSC: Data collection, critical review. HH: Data collection, critical review. BSM: Data collection, critical review. KYL: Data collection, critical review. NKK: Study idea, design, data collection and analysis, manuscript writing
The authors would like to thank Dong-Su Jang, MFA (Medical Illustrator) for his help with the illustrations.
Human Rights Statement
All procedures were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. This retrospective study was approved by the Institutional Review Board (IRB) of Severance Hospital, Yonsei University College of Medicine (4-2018-0191).
Owing to the retrospective nature of the study, signed patient informed consent was waived as per the IRB approval.
Seung Yoon Yang, Youn Young Park, Yoon Dae Han, Min Soo Cho, Hyuk Hur, Byung Soh Min, Kang Young Lee, and Nam Kyu Kim have no disclosures to declare.
Conflict of Interest
All authors have completed the disclosure declaration, and none of the authors or their immediate family members report any conflicting financial interest.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Yang, S.Y., Park, Y.Y., Han, Y.D. et al. Oncologic Outcomes of Self-Expandable Metallic Stent as a Bridge to Surgery and Safety and Feasibility of Minimally Invasive Surgery for Acute Malignant Colonic Obstruction. Ann Surg Oncol 26, 2787–2796 (2019). https://doi.org/10.1245/s10434-019-07346-3