Optimal Timing of Surgery After Insertion of Self-Expandable Metallic Stent to Obstructive Colorectal Neoplasm as a Bridge to Surgery

초록

Background and AimsColonic stenting using self-expandable metallic stents (SEMS) as a bridge to surgery offers an effective alternative to emergency surgery for the management of malignant colorectal obstruction. However, the optimal timing of elective surgery after stenting remains controversial.MethodsThis retrospective multicenter cohort study analyzed 380 patients with obstructive colorectal cancer who were treated with SEMS as a bridge to surgery. Patients were categorized into four groups based on the time from stent insertion to surgery: within 7 days, 8-14 days, 15-21 days, and 22 days or more.ResultsThe study cohort had a slight male predominance (55.8%), with an average age of 65.8 years. Most surgeries (74.2%) were laparoscopically performed. No significant differences were observed in stoma formation rates or postoperative complications between the different timing groups. Similarly, recurrence-free survival, overall survival, locoregional recurrence, and distant metastasis rates showed no significant variations with the timing of post-stenting surgery. A restricted cubic spline curve indicated that surgery within the 15-21-day period post-SEMS insertion resulted in the lowest incidence of stoma formation.ConclusionsDelaying elective surgery for up to 3 weeks post-SEMS placement for obstructive colorectal cancer is recommended, particularly within the 15-21-day period, to minimize stoma formation rates without compromising on long-term outcomes.

키워드