Comparison of survival and perioperative outcome of the colonic stent and the transanal decompression tube placement and
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ORIGINAL ARTICLE
Comparison of survival and perioperative outcome of the colonic stent and the transanal decompression tube placement and emergency surgery for left-sided obstructive colorectal cancer: a retrospective multi-center observational study “The CODOMO study” Shungo Endo 1
&
K. Kumamoto 1 & T. Enomoto 2 & K. Koizumi 3 & H. Kato 4 & Y. Saida 2
Accepted: 19 November 2020 # The Author(s) 2020
Abstract Purpose Advances in endoscopic technology have led to the reevaluation of self-expandable metallic stent (SEMS) placement as a bridge-to-surgery (BTS) in patients with obstructive colorectal cancer. In Japan, after inclusion of SEMS placement as a BTS in the medical insurance coverage in 2012, this procedure has been increasingly performed. However, a transanal decompression tube (TADT) placement has been used as a BTS. We aimed to retrospectively evaluate the optimal strategy for obstructive leftsided colorectal cancer (OLCRC) by comparing SEMS and TADT placement with emergency surgery. Methods We included 301 patients with stage II and III OLCRC from 27 institutions. The study patients were divided into Surgery group (emergency surgery, n = 103), SEMS group (BTS by SEMS, n = 113), and TADT group (BTS by TADT, n = 85). We compared the survival and perioperative outcomes of patients in the Surgery group as a standard treatment with those in the SEMS and TADT groups. Results The 3-year relapse-free survival rate in patients in the Surgery group was 74.8%, while that in patients in the SEMS group and TADT group were 69.0% (p = 0.39) and 55.3% (p = 0.006), respectively. The technical success rate was not statistically different, but the clinical success rate was significantly higher in the SEMS group than in the TADT group (p = 0.0040). With regard to postoperative complications after curative surgery, the SEMS group had significantly lower of complications (≥ grade 2) than the Surgery group (p = 0.022). Conclusion Patients who underwent SEMS placement for OLCRC had similar oncological outcomes to patients who underwent emergency surgery. Keywords Obstructive colorectal cancer . Bridge to surgery . Self-expanding metallic stent . Transanal decompression tube . Emergency surgery
Introduction * Shungo Endo [email protected] 1
Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Aizu-Wakamatsu City, Fukushima 969-3492, Japan
2
Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
3
Department of Gastroenterology, Tokyo Metropolitan Cancer Infectious Disease Center Komagome Hospital, Tokyo, Japan
4
Department of Clinical Laboratory and Endoscopy, Tokyo Women’s Medical University, Medical Center East, Tokyo, Japan
Colorectal cancer (CRC) is the most common cancer in the gastrointestinal tract in the world [1]. The incidence of obstruction in left-sided CRC was reported to be higher than that in right-sided CRC. Moreover, 8–16% of CRC patients initially present with bowel obstruction, which accounts for 85% of colonic emergencies [1, 2]. Treatment for obst
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