The optimal time interval between the placement of self-expandable metallic stent and elective surgery in patients with obstructive colon cancer

Abstract

A bridge to surgery (BTS) after a colonic stent for obstructive colon cancer has not been accepted as a standard treatment strategy. Also, there is no consensus regarding the optimal time interval for BTS. We aimed to identify the optimal timing for BTS after stent placement to decrease the oncologic risk. We retrospectively collected data of 174 patients who underwent BTS after stent placement for stage II or III obstructive colon cancer from five hospitals. We divided the patients into three groups based on the time interval for BTS after stent placement: within 7 days (Group 1), from 8 to 14 days (Group 2), and after 14 days (Group 3). The primary outcome was to compare the oncologic outcomes including overall survival (OS), disease-free survival (DFS), and recurrence rate (RR) among the three groups. Groups 1, 2, and 3 involved 75, 56, and 43 patients, respectively. Postoperative morbidity rates were 17.3%, 10.8%, and 9.3% in Groups 1, 2, and 3, respectively (P = 0.337). RRs were 16.0%, 35.7%, and 30.2% in Groups 1, 2, and 3, respectively (P = 0.029). In multivariate analysis, the time interval for BTS was an independent risk factor for DFS (P < 0.001; HR, 14.463; 95% CI, 1.458-3.255) and OS (P = 0.027; HR, 4.917; 95% CI, 1.071-3.059). In conclusion, the perioperative short-term outcome was not affected by the time interval of BTS. However, elective surgery within 7 days after colonic stent might be suggested to balance the short-term benefits and long-term oncologic risks.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1

Long-term oncologic outcomes including disease-free survival (DFS) and overall survival (OS) based on the time interval between stent placement and definitive surgery. DFS and OS are significantly different among the three groups (P = 0.033 and P = 0.002). Comparing DFS between the pairs (Group 1 vs Group 2 and Group 1 vs Group 3), there were significant differences (P = 0.014 and P = 0.036). Comparing OS between the pairs (Group 1 vs Group 3 and Group 2 vs Group 3), there were significant differences (P = 0.002 and P = 0.002). P-values and CIs have been corrected for multiple testing (Bonferroni correction).

Figure 2

Long-term oncologic outcomes including disease-free survival (DFS) and overall survival (OS) based on the time interval between stent placement and definitive surgery in stage II and stage III, respectively. (a) DFS curve in stage II, (b) OS in stage II, (c) DFS curve in stage III, and (d) OS in stage III. In both stage II and stage III, DFS in Group I is better than that in Group 2 or 3. In stage III, OS in Group 3 is significantly worse than that in Group 1 or 2. P-values and CIs have been corrected for multiple testing (Bonferroni correction).