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.

Authors:
Seung Yoon Yang
Seung Yoon Yang
Yonsei University College of Medicine
South Korea
Youn Young Park
Youn Young Park
Kyung Hee University School of Medicine
Yoon Dae Han
Yoon Dae Han
Yonsei University College of Medicine
Min Soo Cho
Min Soo Cho
Yonsei University College of Medicine
South Korea
Hyuk Hur
Hyuk Hur
Yonsei University College of Medicine
South Korea
Byung Soh Min
Byung Soh Min
Yonsei University College of Medicine
South Korea
Kang Young Lee
Kang Young Lee
Yonsei University College of Medicine
South Korea
Nam Kyu Kim
Nam Kyu Kim
Yonsei University College of Medicine
South Korea

Ann Surg Oncol 2019 Apr 15. Epub 2019 Apr 15.

Division of Colon and Rectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

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http://dx.doi.org/10.1245/s10434-019-07346-3DOI Listing
April 2019
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