Skip to main content

Advertisement

SpringerLink
Log in

Colonic stenting as a bridge to surgery for obstructive colon cancer: is it safe in the long term?

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The placement of a self-expanding metal stent in patients with obstructive colon cancer is used as a bridge to surgery. However, due to a lack of consensus and insufficient data, the long-term oncologic outcomes after colonic SEMS placement remain unclear. We assessed the long-term oncologic outcomes and adverse effects of colonic stenting for malignant colonic obstruction.

Methods

We included 198 patients admitted to Korea University Anam Hospital between 2006 and 2014 for obstructive colon cancer, of whom 98 underwent SEMS placement as a bridge to surgery and 100 underwent direct surgery without stenting. The clinicopathologic characteristics, overall survival, and disease-free survival were compared.

Results

There were no significant differences in long-term oncologic outcomes between the two groups. The median follow-up durations were 61.55 and 58.64 months in the SEMS and DS groups, respectively. There were also no significant differences in the 5-year OS (77.4% vs. 74.2%, p = 0.691) and 5-year DFS (61.7% vs. 71.0%, p = 0.194) rates between the groups. However, the DS group had significantly more early postoperative complications (p = 0.002).

Conclusions

Colonic SEMS deployment as a bridge to surgery did not negatively affect long-term oncologic outcomes when compared with DS. In addition, colonic stenting decreased early postoperative complications and reduced the time for patients to return to normal daily activities.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68:394–424

    Article  PubMed  Google Scholar 

  2. Arnold M, Sierra MS, Laversanne M, Soerjomataram I, Jemal A, Bray F (2017) Global patterns and trends in colorectal cancer incidence and mortality. Gut 66:683–691

    Article  PubMed  Google Scholar 

  3. Hofseth LJ, Hebert JR, Chanda A, Chen H, Love BL, Pena MM, Murphy EA, Sajish M, Sheth A, Buckhaults PJ, Berger FG (2020) Early-onset colorectal cancer: initial clues and current views. Nat Rev Gastroenterol Hepatol 17:352–364

    Article  PubMed  Google Scholar 

  4. Deans GT, Krukowski ZH, Irwin ST (1994) Malignant obstruction of the left colon. Br J Surg 81:1270–1276

    Article  CAS  PubMed  Google Scholar 

  5. Pirlet IA, Slim K, Kwiatkowski F, Michot F, Millat BL (2011) Emergency preoperative stenting versus surgery for acute left-sided malignant colonic obstruction: a multicenter randomized controlled trial. Surg Endosc 25:1814–1821

    Article  PubMed  Google Scholar 

  6. Tekkis PP, Kinsman R, Thompson MR, Stamatakis JD, Association of Coloproctology of Great Britain I (2004) The Association of Coloproctology of Great Britain and Ireland study of large bowel obstruction caused by colorectal cancer. Ann Surg 240:76–81

    Article  PubMed  PubMed Central  Google Scholar 

  7. Alves A, Panis Y, Mathieu P, Mantion G, Kwiatkowski F, Slim K, Association Francaise de C (2005) Postoperative mortality and morbidity in French patients undergoing colorectal surgery: results of a prospective multicenter study. Arch Surg 140:278–283, discussion 284

  8. Mealy K, O’Broin E, Donohue J, Tanner A, Keane FB (1996) Reversible colostomy–what is the outcome? Dis Colon Rectum 39:1227–1231

    Article  CAS  PubMed  Google Scholar 

  9. Tejero E, Mainar A, Fernandez L, Tobio R, De Gregorio MA (1994) New procedure for the treatment of colorectal neoplastic obstructions. Dis Colon Rectum 37:1158–1159

    Article  CAS  PubMed  Google Scholar 

  10. Targownik LE, Spiegel BM, Sack J, Hines OJ, Dulai GS, Gralnek IM, Farrell JJ (2004) Colonic stent vs. emergency surgery for management of acute left-sided malignant colonic obstruction: a decision analysis. Gastrointest Endosc 60:865–874

    Article  PubMed  Google Scholar 

  11. Allievi N, Ceresoli M, Fugazzola P, Montori G, Coccolini F, Ansaloni L (2017) Endoscopic stenting as bridge to surgery versus emergency resection for left-sided malignant colorectal obstruction: an updated meta-analysis. Int J Surg Oncol 2017:2863272

    PubMed  PubMed Central  Google Scholar 

  12. Furuke H, Komatsu S, Ikeda J, Tanaka S, Kumano T, Imura KI, Shimomura K, Taniguchi F, Ueshima Y, Takashina KI, Lee CJ, Deguchi E, Ikeda E, Otsuji E, Shioaki Y (2018) Self-expandable metallic stents contribute to reducing perioperative complications in colorectal cancer patients with acute obstruction. Anticancer Res 38:1749–1753

    PubMed  Google Scholar 

  13. van Hooft JE, Bemelman WA, Oldenburg B, Marinelli AW, Lutke Holzik MF, Grubben MJ, Sprangers MA, Dijkgraaf MG, Fockens P, collaborative Dutch Stent-In study group (2011) Colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a multicentre randomised trial. Lancet Oncol 12:344–352

    Article  PubMed  Google Scholar 

  14. Veld JV, Amelung FJ, Borstlap WAA, van Halsema EE, Consten ECJ, Siersema PD, Ter Borg F, van der Zaag ES, de Wilt JHW, Fockens P, Bemelman WA, van Hooft JE, Tanis PJ, Dutch Snapshot Research Group (2020) Comparison of decompressing stoma vs stent as a bridge to surgery for left-sided obstructive colon cancer. JAMA Surg 155:206–215

  15. Baron TH, Rey JF, Spinelli P (2002) Expandable metal stent placement for malignant colorectal obstruction. Endoscopy 34:823–830

    Article  CAS  PubMed  Google Scholar 

  16. Lara-Romero C, Vilches A, Caunedo-Alvarez A, Hergueta-Delgado P, Lavin-Castejon I, Andrade-Bellido R, Alcain-Martinez G (2019) 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

    Article  PubMed  Google Scholar 

  17. Park SJ, Lee KY, Kwon SH, Lee SH (2016) Stenting as a bridge to surgery for obstructive colon cancer: Does it have surgical merit or oncologic demerit? Ann Surg Oncol 23:842–848

    Article  PubMed  Google Scholar 

  18. Yang SY, Park YY, Han YD, Cho MS, Hur H, Min BS, Lee KY, Kim NK (2019) 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

    Article  PubMed  Google Scholar 

  19. Alcantara M, Serra-Aracil X, Falco J, Mora L, Bombardo J, Navarro S (2011) Prospective, controlled, randomized study of intraoperative colonic lavage versus stent placement in obstructive left-sided colonic cancer. World J Surg 35:1904–1910

    Article  CAS  PubMed  Google Scholar 

  20. van Hooft JE, van Halsema EE, Vanbiervliet G, Beets-Tan RG, DeWitt JM, Donnellan F, Dumonceau JM, Glynne-Jones RG, Hassan C, Jimenez-Perez J, Meisner S, Muthusamy VR, Parker MC, Regimbeau JM, Sabbagh C, Sagar J, Tanis PJ, Vandervoort J, Webster GJ, Manes G, Barthet MA, Repici A, European Society of Gastrointestinal E (2014) Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 46:990–1053

  21. Arezzo A, Balague C, Targarona E, Borghi F, Giraudo G, Ghezzo L, Arroyo A, Sola-Vera J, De Paolis P, Bossotti M, Bannone E, Forcignano E, Bonino MA, Passera R, Morino M (2017) 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 31:3297–3305

    Article  PubMed  Google Scholar 

  22. Sabbagh C, Browet F, Diouf M, Cosse C, Brehant O, Bartoli E, Mauvais F, Chauffert B, Dupas JL, Nguyen-Khac E, Regimbeau JM (2013) 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 258:107–115

    Article  PubMed  Google Scholar 

  23. Tung KL, Cheung HY, Ng LW, Chung CC, Li MK (2013) 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 6:78–81

    Article  PubMed  Google Scholar 

  24. Cao Y, Gu J, Deng S, Li J, Wu K, Cai K (2019) Long-term tumour outcomes of self-expanding metal stents as ‘bridge to surgery’ for the treatment of colorectal cancer with malignant obstruction: a systematic review and meta-analysis. Int J Colorectal Dis 34:1827–1838

    Article  PubMed  Google Scholar 

  25. Maruthachalam K, Lash GE, Shenton BK, Horgan AF (2007) Tumour cell dissemination following endoscopic stent insertion. Br J Surg 94:1151–1154

    Article  CAS  PubMed  Google Scholar 

  26. Yamashita S, Tanemura M, Sawada G, Moon J, Shimizu Y, Yamaguchi T, Kuwai T, Urata Y, Kuraoka K, Hatanaka N, Yamashita Y, Taniyama K (2018) Impact of endoscopic stent insertion on detection of viable circulating tumor cells from obstructive colorectal cancer. Oncol Lett 15:400–406

    PubMed  Google Scholar 

  27. Kim HJ, Choi GS, Park JS, Park SY, Jun SH (2013) Higher rate of perineural invasion in stent-laparoscopic approach in comparison to emergent open resection for obstructing left-sided colon cancer. Int J Colorectal Dis 28:407–414

    Article  PubMed  Google Scholar 

  28. Choi JM, Lee C, Han YM, Lee M, Choi YH, Jang DK, Im JP, Kim SG, Kim JS, Jung HC (2014) Long-term oncologic outcomes of endoscopic stenting as a bridge to surgery for malignant colonic obstruction: comparison with emergency surgery. Surg Endosc 28:2649–2655

    Article  PubMed  Google Scholar 

  29. Kang SI, Oh HK, Yoo JS, Ahn S, Kim MH, Kim MJ, Son IT, Kim DW, Kang SB, Park YS, Yoon CJ, Shin R, Heo SC, Lee IT, Youk EG, Kim MJ, Chang TY, Park SC, Sohn DK, Oh JH, Park JW, Ryoo SB, Jeong SY, Park KJ, Seoul Colorectal Group (2018) Oncologic outcomes of preoperative stent insertion first versus immediate surgery for obstructing left-sided colorectal cancer. Surg Oncol 27:216–224

  30. Kye BH, Lee YS, Cho HM, Kim JG, Oh ST, Lee IK, Kang WK, Ahn CH, Lee SC, Park JK, Kim HJ (2016) Comparison of long-term outcomes between emergency surgery and bridge to surgery for malignant obstruction in right-sided colon cancer: A multicenter retrospective study. Ann Surg Oncol 23:1867–1874

    Article  PubMed  Google Scholar 

  31. Ross A, Rusnak C, Weinerman B, Kuechler P, Hayashi A, MacLachlan G, Frew E, Dunlop W (1999) Recurrence and survival after surgical management of rectal cancer. Am J Surg 177:392–395

    Article  CAS  PubMed  Google Scholar 

  32. Krasna MJ, Flancbaum L, Cody RP, Shneibaum S, Ben Ari G (1988) Vascular and neural invasion in colorectal carcinoma. Incidence and prognostic significance. Cancer 61:1018–1023

    Article  CAS  PubMed  Google Scholar 

  33. Liebig C, Ayala G, Wilks J, Verstovsek G, Liu H, Agarwal N, Berger DH, Albo D (2009) Perineural invasion is an independent predictor of outcome in colorectal cancer. J Clin Oncol 27:5131–5137

    Article  PubMed  PubMed Central  Google Scholar 

  34. Cao Y, Yang M, Yan L, Deng S, Gu J, Mao F, Wu K, Liu L, Cai K (2020) Colon metal stents as a bridge to surgery had no significant effects on the perineural invasion: a retrospective study. World J Surg Oncol 18:77

    Article  PubMed  PubMed Central  Google Scholar 

  35. Tan CJ, Dasari BV, Gardiner K (2012) 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 99:469–476

    Article  CAS  PubMed  Google Scholar 

  36. van Hooft JE, Veld JV, Arnold D, Beets-Tan RGH, Everett S, Gotz M, van Halsema EE, Hill J, Manes G, Meisner S, Rodrigues-Pinto E, Sabbagh C, Vandervoort J, Tanis PJ, Vanbiervliet G, Arezzo A (2020) Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2020. Endoscopy 52:389–407

    Article  PubMed  Google Scholar 

  37. Lauro A, Binetti M, Vaccari S, Cervellera M, Tonini V (2020) Obstructing left-sided colonic cancer: Is endoscopic stenting a bridge to surgery or a bridge to nowhere? Dig Dis Sci 65:2789–2799

    Article  PubMed  Google Scholar 

  38. Biondo S, Pares D, Kreisler E, Rague JM, Fraccalvieri D, Ruiz AG, Jaurrieta E (2005) Anastomotic dehiscence after resection and primary anastomosis in left-sided colonic emergencies. Dis Colon Rectum 48:2272–2280

    Article  PubMed  Google Scholar 

  39. Li B, Cai SL, Lv ZT, Zhou PH, Yao LQ, Shi Q, Qi ZP, Sun D, Yalikong A, Xu EP, Xu JM, Zhong YS (2020) Self-expandable metallic stenting as a bridge to elective surgery versus emergency surgery for acute malignant right-sided colorectal obstruction. BMC Surg 20:326

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This work was supported by a grant from the National Research Foundation of Korea, funded by the Korean Government (NRF-2019R1C1C1009819).

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, 126-1, Anam-dong 5 ga, Seongbuk-gu, Seoul, 02841, Republic of Korea

    Seung Han Kim, Se Hyun Jang, Han Jo Jeon, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Yoon Tae Jeen & Hoon Jai Chun

  2. Division of Colorectal Surgery, Department of Surgery, Korea University College of Medicine, Robotic & MIS Center, Korea University Medical Center, Seoul, Republic of Korea

    Jin Kim

Authors
  1. Seung Han Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Se Hyun Jang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Han Jo Jeon
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hyuk Soon Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eun Sun Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bora Keum
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yoon Tae Jeen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hoon Jai Chun
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jin Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Bora Keum or Jin Kim.

Ethics declarations

Disclosures

Drs. Seung Han Kim, Se Hyun Jang, Han Jo Jeon, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Yoon Tae Jeen, Hoon Jai Chun, and Jin Kim have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, S.H., Jang, S.H., Jeon, H.J. et al. Colonic stenting as a bridge to surgery for obstructive colon cancer: is it safe in the long term?. Surg Endosc 36, 4392–4400 (2022). https://doi.org/10.1007/s00464-021-08789-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-021-08789-0

Keywords

Search

Navigation