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Comparison of Clinical Outcomes and Pathological Characteristics of Self-Expandable Stent Bridge to Surgery and Emergency Surgery in Obstructive Colon Cancer

Authors Wang B, Lu S, Song Z, Li F, Ma J, Ma Y, Zhou X, Fu W

Received 4 October 2019

Accepted for publication 13 February 2020

Published 9 March 2020 Volume 2020:12 Pages 1725—1732


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Yong Teng

Bingyan Wang,1,* Siyi Lu,1,* Zhiqiang Song,2 Fei Li,1 Junren Ma,1 Yanpeng Ma,1 Xin Zhou,1 Wei Fu1

1Department of General Surgery, Peking University Third Hospital, Beijing, People’s Republic of China; 2Department of Gastroenterology, Peking University Third Hospital, Beijing, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Wei Fu
Department of General Surgery, Peking University Third Hospital, Beijing 100191, People’s Republic of China

Aim: Obstructive colon cancer can be treated by self-expanding metal stents (SEMS) prior to definitive surgery. However, the oncological outcome remains controversial, especially regarding whether stent placement or obstruction results in more perineural invasion (PNI) or lymphovascular invasion (LVI). This study aimed to compare clinical outcomes of emergency surgery (ES) and stent as bridge to surgery (SBTS) in patients with obstructive colon cancer. The pathological characteristics were also compared between obstructive and nonobstructive cancer.
Methods: This study included 880 patients (including 47 ES and 45 SBTS) admitted to Peking University Third Hospital from January 2010 to December 2018. Short-term and long-term outcomes were compared. The pathological differences between an equal number of obstructive and nonobstructive patients matched using propensity scores were investigated.
Results: SBTS patients had less intraoperative blood loss (P < 0.001), shorter ICU stay time (P = 0.007), lower incidence of colostomy (P < 0.001), and higher laparoscopic achievement (P < 0.001) than did ES patients. No pathological difference was found between the two groups. SBTS patients showed better overall survival (86.7% vs 68.1%, P = 0.029), but not disease-free survival (68.9% vs 59.6%, P = 0.211) than did ES patients. PNI was significantly higher in obstructive cancer than in nonobstructive cancer (29.3% vs 16.3%, P = 0.035).
Conclusion: SBTS had a lower incidence of short-term complications and did not affect long-term prognosis compared with that of ES, indicating that SBTS is a safe and effective treatment. Further, PNI may be associated with obstruction, but not with stent insertion.

Keywords: colon obstruction, stenting, bridge to surgery, perineural invasion

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