Short-term effect of different time interval between self-expanding metallic stent and surgery for left-sided malignant colorectal obstruction.

Abstract

Background: The optimal time interval between self-expanding metallic stent (SEMS) placement and surgery in patients with left-sided malignant colorectal obstruction (LMCO) remains controversial. Intestinal obstruction and SEMS placement would lead to intestinal edema, local tumor infiltration, and fibrosis, which may have a certain impact on elective surgery. Although prolong time interval would reduce relative complications, the risk of tumor progression must be taken into account. Therefore, our study proposes whether there is a difference in short-term postoperative complication outcomes between waiting for an interval of ≤4weeks compared with an extended interval for neoadjuvant chemotherapy followed by surgery.

Methods: All patients who underwent SEMS placement as BTS treatment for LMCO between January 2012 and December 2021 were retrospectively identified. The primary outcomes of this study were short-term clinical postoperative complications (Clavien-Dindo grading ≥II).

Results: Of the 148 patients, 70.27% of patients underwent surgery ≤4 weeks of SEMS placement (Group 1) while 29.73% of patients underwent surgery >4 weeks of SEMS placement (Group 2). After SEMS placement, the patients in Group 2 received neoadjuvant chemotherapy and then elective surgery. Significant differences were observed between both groups (Group 2 vs Group 1) for postoperative complications (Clavien-Dindo grading ≥II, 2.3% vs 14.4%, p=0.040), postoperative bowel function time (p<0.001), postoperative hospital stay (p=0.028) and total hospital stay (p=0.002).

Conclusions: A bridging interval of >4 weeks between SEMS placement and surgery for LMCO has better short-term clinical outcome.