Skip to main content

Advertisement

SpringerLink
Log in

A longer interval after stenting compromises the short- and long-term outcomes after curative surgery for obstructive colorectal cancer

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

Intestinal decompression using self-expandable metallic colonic stents (SEMSs) as a bridge to surgery is now considered an attractive alternative to emergency surgery. However, data regarding the optimal timing of surgery after stenting are limited.

Methods

We investigated the impact of the interval between stenting and surgery on short- and long-term outcomes in 92 obstructive colorectal cancer (OCRC) patients who had a SEMS inserted and subsequently received curative surgery.

Results

The median age of the patients was 70.5 years, and the median interval between SEMS insertion and the surgery was 17 (range 5–47) days. There were 35 postoperative complications, including seven major postoperative complications. An interval of more than 16 days was an independent predictor of a poor relapse-free survival (hazard ratio [HR] = 3.12, 95% confidence interval [CI] 1.24–7.81, p = 0.015). An interval of more than 35 days was independently associated with major postoperative complications (HR = 16.6, 95% CI 2.21–125, p = 0.006).

Conclusion

A longer interval between stenting and surgery significantly compromised the short- and long-term outcomes. Surgery within 16 days after stenting might help maximize the benefit of SEMS without interfering with short- and long-term outcomes.

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

Similar content being viewed by others

References

  1. The Global Cancer Observatory. 2020. https://gco.iarc.fr/ Accessed 6 June 2021.

  2. McCullough JA, Engledow AH. Treatment options in obstructed left-sided colonic cancer. Clin Oncol. 2010;22:764–70.

    Article  CAS  Google Scholar 

  3. Matsuda A, Miyashita M, Matsumoto S, et al. Comparison of long-term outcomes of colonic stent as “bridge to surgery” and emergency surgery for malignant large-bowel obstruction: a meta-analysis. Ann Surg Oncol. 2015;22:497–504.

    Article  Google Scholar 

  4. van Hooft JE, Veld JV, Arnold D, Beets-Tan RGH, Everett S, Götz M, et al. Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline—update 2020. Endoscopy. 2020;52:389–407.

    Article  Google Scholar 

  5. Arezzo A, Passera R, Lo Secco G, Verra M, Bonino MA, Targarona E, et al. Stent as bridge to surgery for left-sided malignant colonic obstruction reduces adverse events and stoma rate compared with emergency surgery: results of a systematic review and meta-analysis of randomized controlled trials. Gastrointest Endosc. 2017;86:416–26.

    Article  Google Scholar 

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

    PubMed  PubMed Central  Google Scholar 

  7. Dohomoto M. New method-endoscopic implantation of rectal stent in palliative treatment of malignant stenosis. Endosc Dig. 1991;3:1507–12.

    Google Scholar 

  8. van Hooft JE, van Halsema EE, Vanbiervliet G, Beets-Tan RG, DeWitt JM, Donnellan F, European Society of Gastrointestinal Endoscopy, 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.

    Article  Google Scholar 

  9. Matsuzawa T, Ishida H, Yoshida S, Isayama H, Kuwai T, Maetani I, et al. A Japanese prospective multicenter study of self-expandable metal stent placement for malignant colorectal obstruction: short-term safety and efficacy within 7 days of stent procedure in 513 cases. Gastrointest Endosc. 2015;82:697–707.

    Article  Google Scholar 

  10. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  Google Scholar 

  11. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, et al. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.

    Google Scholar 

  12. Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transpl. 2013;48:452–8.

    Article  CAS  Google Scholar 

  13. Frago R, Ramirez E, Millan M, Kreisler E, del Valle E, Biondo S. Current management of acute malignant large bowel obstruction: a systematic review. Am J Surg. 2014;207:127–38.

    Article  Google Scholar 

  14. Gainant A. Emergency management of acute colonic cancer obstruction. J Visc Surg. 2012;149:e3-10.

    Article  CAS  Google Scholar 

  15. Kye BH, Kim JH, Kim HJ, Lee YS, Lee IK, Kang WK, et al. The optimal time interval between the placement of self-expandable metallic stent and elective surgery in patients with obstructive colon cancer. Sci Rep. 2020;10:9502.

    Article  CAS  Google Scholar 

  16. Broholm M, Kobborg M, Frostberg E, Jeppesen M, Gögenür I. Delay of surgery after stent placement for resectable malignant colorectal obstruction is associated with higher risk of recurrence. Int J Colorectal Dis. 2017;32:513–6.

    Article  Google Scholar 

  17. Veld JV, Kumcu A, Amelung FJ, Borstlap WAA, Consten ECJ, Dekker JWT, et al. Time interval between self-expandable metal stent placement or creation of a decompressing stoma and elective resection of left-sided obstructive colon cancer. Endoscopy. 2020. https://doi.org/10.1055/a-1308-1487.

    Article  PubMed  Google Scholar 

  18. Yamashita S, Tanemura M, Sawada G, Moon J, Shimizu Y, Yamaguchi T, et al. Impact of endoscopic stent insertion on detection of viable circulating tumor cells from obstructive colorectal cancer. Oncol Lett. 2018;15:400–6.

    PubMed  Google Scholar 

  19. Maruthachalam K, Lash GE, Shenton BK, Horgan AF. Tumour cell dissemination following endoscopic stent insertion. Br J Surg. 2007;94:1151–4.

    Article  CAS  Google Scholar 

  20. Takahashi G, Yamada T, Iwai T, Takeda K, Koizumi M, Shinji S, et al. Oncological assessment of stent placement for obstructive colorectal cancer from circulating cell-free DNA and circulating tumor DNA dynamics. Ann Surg Oncol. 2018;25:737–44.

    Article  Google Scholar 

  21. Haraguchi N, Ikeda M, Miyake M, Yamada T, Sakakibara Y, Mita E, et al. Colonic stenting as a bridge to surgery for obstructive colorectal cancer: advantages and disadvantages. Surg Today. 2016;46:1310–7.

    Article  CAS  Google Scholar 

  22. Kim HJ, Choi GS, Park JS, Park SY, Jun SH. 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. 2013;28:407–14.

    Article  Google Scholar 

  23. Foo CC, Poon SHT, Chiu RHY, Lam WY, Cheung LC, Law WL. Is bridge to surgery stenting a safe alternative to emergency surgery in malignant colonic obstruction: a meta-analysis of randomized control trials. Surg Endosc. 2019;33:293–302.

    Article  Google Scholar 

  24. Ribeiro IB, Bernardo WM, Martins BDC, de Moura DTH, Baba ER, Josino IR, et al. Colonic stent versus emergency surgery as treatment of malignant colonic obstruction in the palliative setting: a systematic review and meta-analysis. Endosc Int Open. 2018;6:E558–67.

    Article  Google Scholar 

  25. Sato R, Oikawa M, Kakita T, Okada T, Oyama A, Abe T, et al. Comparison of the long-term outcomes of the self-expandable metallic stent and transanal decompression tube for obstructive colorectal cancer. Ann Gastroenterol Surg. 2019;3:209–16.

    Article  Google Scholar 

  26. Matsuda A, Miyashita M, Matsumoto S, Sakurazawa N, Kawano Y, Yamada T, et al. Optimal interval from placement of a self-expandable metallic stent to surgery in patients with malignant large bowel obstruction: a preliminary study. Surg Laparosc Endosc Percutan Tech. 2018;28:239–44.

    Article  Google Scholar 

  27. Lee GJ, Kim HJ, Baek JH, Lee WS, Kwon KA. Comparison of short-term outcomes after elective surgery following endoscopic stent insertion and emergency surgery for obstructive colorectal cancer. Int J Surg. 2013;11:442–6.

    Article  Google Scholar 

  28. Saito S, Yoshida S, Isayama H, Matsuzawa T, Kuwai T, Maetani I, et al. A prospective multicenter study on self-expandable metallic stents as a bridge to surgery for malignant colorectal obstruction in Japan: efficacy and safety in 312 patients. Surg Endosc. 2016;30:3976–86.

    Article  Google Scholar 

  29. Hashiguchi Y, Muro K, Saito Y, Ito Y, Ajioka Y, Hamaguchi T, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol. 2020;25:1–42.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan

    Ryuichiro Sato, Masaya Oikawa, Tetsuya Kakita, Takaho Okada, Tomoya Abe, Takashi Yazawa, Haruyuki Tsuchiya, Naoya Akazawa, Shingo Yoshimachi & Takashi Tsuchiya

  2. Department of Gastroenterology, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan

    Tetsuya Ohira, Yoshihiro Harada, Haruka Okano & Kei Ito

  3. Department of Surgery, Japanese Red Cross Sendai Hospital, 2-43-3 Yagiyama hon-cho, Taihaku-ku, Sendai, 982-8501, Japan

    Ryuichiro Sato

Authors
  1. Ryuichiro Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masaya Oikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tetsuya Kakita
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takaho Okada
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tomoya Abe
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takashi Yazawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Haruyuki Tsuchiya
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Naoya Akazawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shingo Yoshimachi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Tetsuya Ohira
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yoshihiro Harada
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Haruka Okano
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Kei Ito
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Takashi Tsuchiya
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ryuichiro Sato.

Ethics declarations

Conflict of interest

We have no conflict of interest to declare.

Additional information

Publisher's Note

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

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (XLSX 26 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sato, R., Oikawa, M., Kakita, T. et al. A longer interval after stenting compromises the short- and long-term outcomes after curative surgery for obstructive colorectal cancer. Surg Today 52, 681–689 (2022). https://doi.org/10.1007/s00595-021-02385-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-021-02385-4

Keywords

Search

Navigation