Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

The prognostic impact of bowel perforation following self-expanding metal stent as a bridge to surgery in colorectal cancer obstruction

  • 442 Accesses

  • 6 Citations

Abstract

Background

Self-expanding metallic stent (SEMS) as a bridge to surgery for obstructive colorectal cancer may cause perforation of the tumor and thereby induce tumor spread and increase risk of recurrence, and eventually death. Evidence of the prognostic impact of SEMS-related perforation is, however, sparse. We conducted a long-term follow-up study to compare characteristics, overall survival, and recurrence rates between patients with and without SEMS-related bowel perforation.

Method

This long-term follow-up study included obstructive colorectal cancer patients treated with SEMS as a bridge to surgery during a 10-year period at two primary and tertiary referral centers. The primary outcome was overall survival, and the secondary outcome was recurrence. We compared mortality and recurrence in patients with and without SEMS-related perforations by Cox proportion hazard regression, adjusting for age, comorbidity, and disease stage. The recurrence risk was examined for patients undergoing curative resection and computed treating death as a competing risk.

Results

From January 2004 to December 2013, 123 patients were treated with SEMS as a bridge to surgery. Of these patients, 15 (12%) had SEMS-related perforations. Median follow-up was 4.8 years (range 0.0–10.9 years). The overall 5-year survival was 58% for the entire cohort, but 37 and 61% for patients with and without perforations, respectively, corresponding to an adjusted hazard ratio of 1.6 (95% CI 0.8–3.3) in favor of patient without perforation. The overall 5-year recurrence rate was 34%, but 45 and 33% for patients with and without perforation, respectively, corresponding to an adjusted hazard ratio of 1.4 (95% CI 0.5–3.7) in disfavor of patients with perforation.

Conclusion

SEMS-related perforations are common and may be associated with decreased survival and increased recurrence, although estimates in this study were imprecise.

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

We’re sorry, something doesn't seem to be working properly.

Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Fig. 1

References

  1. 1.

    Iversen LH, Bülow S, Christensen IJ, Laurberg S, Harling H (2008) Postoperative medical complications are the main cause of early death after emergency surgery for colonic cancer. Br J Surg 95(8):1012–1019

  2. 2.

    Cuffy M, Abir F, Audisio RA, Longo WE (2004) Colorectal cancer presenting as surgical emergencies. Surg Oncol 13:149–157

  3. 3.

    McArdle CS, Hole DJ (2004) Emergency presentation of colorectal cancer is associated with poor 5-year survival. Br J Surg 91:605–609

  4. 4.

    The Danish Colorectal Cancer Group (2014) DCCG annual report 2014. http://dccg.dk/pdf/Aarsrapport_2014.pdf

  5. 5.

    Sagar J (2011) Colorectal stents for the management of malignant colonic obstructions. Cochrane Database Syst Rev. doi:10.1002/14651858.CD007378.pub2

  6. 6.

    Khot UP, Lang AW, Murali K, Parker MC (2002) Systematic review of the efficacy and safety of colorectal stents. Br J Surg 89:1096–1102

  7. 7.

    Jiménez-Pérez J, Casellas J, García-Cano J, Vandervoort J, Roncero García-Escribano O, Barcenilla J, Álvarez Delgado A, Goldberg P, Gonzalez-Huix F, Vázquez-Astray E, Meisner S (2011) Colonic stenting as a bridge to surgery in malignant large-bowel obstruction: a report from two large multinational registries. Am J Gastroenterol 106:2174–2180

  8. 8.

    Breitenstein S, Rickenbacher A, Berdajs D, Puhan M, Clavien P, Demartines N (2007) Systematic evaluation of surgical strategies for acute malignant left-sided colonic obstruction. Br J Surg 94:1451–1460

  9. 9.

    Alcántara M, Serra-Aracil X, Falcó J, Mora L, Bombardó 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

  10. 10.

    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

  11. 11.

    Van Hooft JE, Bemelman WA, Oldenburg B, Marinelli AW, Holzik MFL, Grubben MJ, Sprangers MA, Dijkgraaf MG, Fockens P, the 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

  12. 12.

    Bülow S, Christensen IJ, Iversen LH, Harling H, the Danish Colorectal Cancer Group (2011) Intra-operative perforation is an important predictor of local recurrence and impaired survival after abdominoperineal resection for rectal cancer. Colorectal Dis 13:1256–1264

  13. 13.

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

  14. 14.

    Gorissen KJ, Tuynman JB, Fryer E, Wang L, Uberoi R, Jones OM, Cunningham C, Lindsey I (2013) Local recurrence after stenting for obstructing left-sided colonic cancer. Br J Surg 100:1805–1809

  15. 15.

    Erichsen R, Horváth-Puhó E, Jacobsen JB, Nilsson T, Baron JA, Sørensen HT (2015) Long-term mortality and recurrence after colorectal cancer surgery with preoperative stenting: a Danish nationwide cohort study. Endoscopy 47:517–524

  16. 16.

    Iversen LH, Kratmann M, Bøje M, Laurberg S (2011) Self-expanding metallic stents as bridge to surgery in obstructing colorectal cancer. Br J Surg 98:275–281

  17. 17.

    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 40:373–383

  18. 18.

    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications. Ann Surg 240:205–213

  19. 19.

    Matsuda A, Miyashita M, Matsumoto S, Matsutani T, Sakurazawa N, Takahashi G, Kishi T, Uchida E (2014) 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 22:497–504

  20. 20.

    Sloothaak DAM, van den Berg MW, Dijkgraaf MGW, Fockens P, Tanis PJ, van Hooft JE, Bemelman WA (2014) Oncological outcome of malignant colonic obstruction in the Dutch Stent-In 2 trial. Br J Surg 101:1751–1757

  21. 21.

    Kim SJ, Kim HW, Park SB, Kang DH, Choi CW, Song BJ, Hong JB, Kim DJ, Park BS, Son GM (2015) 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 29:3499–3506

Download references

Author information

Correspondence to Tue Højslev Avlund.

Ethics declarations

Disclosure

Tue Højslev Avlund, Rune Erichsen, Sissel Ravn, Zydrunas Ciplys, Jens Christian Andersen, Søren Laurberg, and Lene H. Iversen have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Avlund, T.H., Erichsen, R., Ravn, S. et al. The prognostic impact of bowel perforation following self-expanding metal stent as a bridge to surgery in colorectal cancer obstruction. Surg Endosc 32, 328–336 (2018). https://doi.org/10.1007/s00464-017-5680-0

Download citation

Keywords

  • Colonic neoplasms
  • Gastrointestinal endoscopy
  • Surgery