Self-expanding metallic stent as a bridge to surgery versus emergency operation for obstructing left sided colorectal cancer: a case-matched study

Abstract

Introduction: This study aimed to compare the outcomes of patients, who suffered from obstructing left-sided colorectal cancer, treated with self-expanding metallic stent (SEMS) as a bridge to surgery with those who underwent emergency operation. Methods: Twenty patients, who had acute obstruction due to malignant left-sided colorectal cancer, underwent surgical resection after insertion of SEMS (group I) were matched to forty patients with emergency colonic resection (group II). The two groups were compared for the incidence of primary anastomosis, stoma rate, hospital stay, duration of intensive care (ICU stay), post-operative morbidity and mortality. Results: Both groups had similar age, pre-operative co-morbidity and stage of disease, but the tumours in group I were more distally located (p 0.001). In group I, one patient developed colon perforation and required Hartmann’s operation. All the other patients underwent elective operation with primary anastomosis (95%). In group II, primary anastomosis was performed in 29 patients (72.5%). The difference in the incidence of primary anastomosis was significant (p0.047). The operative mortality of group I and group II were 5% and 12.5%, respectively (p0.653). The median postoperative hospital stays for group I and group II were 8 days (range: 4-33days) vs. 10 days (range: 5-48 days), respectively (p0.017). Four patients (20%) in group I and 20 patients in group II (50%) required ICU stay after the operation (p0.029). The re-operation rate, surgical complications and medical complications, however, did not show any statistical differences between the two groups. Conclusion: When compared with emergency resection, insertion of SEMS as a bridge to surgery for obstructing left-sided colorectal cancer is associated with a higher rate of primary anastomosis as well as a better outcome in terms of hospital stay and stay in the ICU. The wider application of this treatment option for obstructing colorectal cancer should be further investigated.