Long-term outcomes of stenting as a bridge to surgery for acute left-sided malignant colonic obstruction

Abstract

INTRODUCTION: Stenting as a bridge to surgery has been increasingly applied in cases of acute left-sided colonic obstruction. This study aims to evaluate both the short and long-term outcomes associated with colonic stenting as a bridge to surgery in patients with obstructing adenocarcinoma of the colon. METHODS: Patients with potentially curable acute left-sided colonic obstruction treated with stenting as a bridge to surgery (28) or with emergency surgical resection (39) from January 1998 to December 2008 were identified using a prospectively maintained database. Short-term data on post-operative mortality, morbidity, necessity of intensive care, and length of hospital stay were compared. Disease-free and overall survival data were also analyzed. RESULTS: Patients within the two study arms had similar demographic profiles. Patients receiving preoperative stenting had a higher likelihood of a laparoscopic resection (P,0.001). Further, the emergency surgery group had a higher rate of postoperative complications (P=0.024), rate of ICU admission (P=0.013), and longer total length of stay (9 vs. 12 days, P=0.001). With a median follow-up of 26.5 and 31.3 months for the stenting and surgical resection groups respectively, there was no difference in overall and disease-free survival (overall survival = 30 vs 31 months, P=0.858; DFS = 13 vs 12 months, P=0.989). As well, there was no difference in the rate of systemic recurrences (8 vs. 13, P=0.991). CONCLUSION: Stenting as a bridge to surgery is a safe treatment strategy in the management of patients with acute left-sided colonic obstruction with improved shortterm outcomes and comparable long-term oncologic results. Further studies are necessary to fully address the utility of colonic stenting as a bridge to curative surgery and to establish its definitive role as a treatment strategy.