Endoscopic stenting for colorectal cancer obstruction as a bridge-to-surgery strategy.

BACKGROUND: Acute obstructive colorectal cancer requires prompt decompression commonly by emergency surgery(ES). However, self-expanding metal stents(SEMS) have been increasingly used as a bridge-to-surgery (BTS) strategy. MATERIALS AND METHODS: In a 8-year period, consecutive patients with acute left-sided colonic obstruction, due to locally advanced colorectal cancer, underwent ES or SEMS implantation. We evaluated technical/clinical success of SEMS, adverse events, overall(OS) and disease-free survival(DFS) of the two therapeutic options. RESULTS: Forty-five patients underwent ES (n=23) or SEMS (n=22). The two groups were comparable for sex, age, ASA score and cancer site/stage. Technical and clinical successes of SEMS were 100% and 72.7% respectively. Clinical success correlated with neutrophil-lymphocyte ratio (NLR) at baseline (OR=0.65, 95%CI 0.43-0.98, p=0.04). SEMS allowed primary anastomosis in the 45.5% of cases (0% in ES). SEMS implantation allowed a higher rate of surgery carried out by a laparoscopic approach: 36.4% vs 13.0% in ES. Performance of a definitive stoma and complications were similar. Median OS (34 in SEMS; 45 in ES, p=0.33) and DFS (36 in SEMS; 35 in ES, p=0.35), did not differ between the two groups. At univariate analysis, DFS was positively associated to primary anastomosis (HR=2.44, 95%CI 1.4-16.6, p=0.04) and laparoscopic surgery (HR=8.33, 95%CI 1.08-50, p=0.04), and inversely to a NLR>3.6 (HR=0.59, 95%CI 0.16-0.92, p=0.03). At multivariate analysis, no feature retained an independent predictive power. CONCLUSION: SEMS is an effective and safe procedure, equivalent to emergency surgery in terms of complications, OS and DFS, providing the chance of a primary anastomosis in the majority of patients.