Quasi-elective left colectomy after endoscopic colon stenting for obstructive cancer yields comparable oncologic outcome to full-elective operation

• DOI: 10.1007/s00384-020-03519-9
• Publication Date: 2020-02-01T01:02:28Z
• Authors: Nicolò Tamini; Marco Ceresoli; Simone Aldè; Francesca Carissimi; Lorenzo Ripamonti; Luca Nespoli; Marco Dinelli; Marco Braga; Luca Gianotti
• Keywords: Male; Colon; Colonoscopy; Middle Aged; Colon cancer; Disease-free survival; Elective surgery; Endoscopy; Obstruction; Outcome; Self-expandable metal stent; Disease-Free Survival; 3. Good health; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Elective Surgical Procedures; Colonic Neoplasms; Humans; Female; Stents; Colectomy; Aged

Whether deferring surgery after endoscopic self-expandable metal stent (SEMS) placement for neoplastic stricture, and operating patients in a quasi-elective situation, may result in similar oncologic outcomes to elective operations is unclear. This study aimed to evaluate the disease-free survival (DFS) rates of patients who underwent an interval colon resection after SEMS placement or an elective operation with comparable cancer stages.From a prospective dataset, we retrospectively selected patients with the following characteristics: (1) left-sided colon cancer and (2) cancer stage I to III. Exclusion criteria were as follows: (1) palliative surgery and (2) emergency operation. Then we stratified patients into two groups: (A) full-elective left colon resection and (B) quasi-elective left colon resection, defined as surgery performed after SEMS placement for obstructive colon cancer. DFS function was studied by the Kaplan-Meier method.After 1:2 matching based on cancer stage, 106 patients of the group A were compared with 53 patients of group B. In each group, there were 9.4% of stage I, 39.4% of stage II, and 50.9% of stage III patients. The rate of technical failure in SEMS placement was 3.8%. After a mean follow-up of 54 months, 16 (15.1%) patients in the full-elective groups and 10 (18.9%) in the quasi-elective group experience cancer recurrence (log rank = 0.588). DFS curve did not reach the median value.SEMS placement with interval colon resection for obstructive neoplastic strictures seems to provide similar long-term oncologic outcomes to operations performed in an elective setting when a low rate of technical failure is achieved.