Long-term prognosis of preoperative "bridge to surgery" expandable metallic stent insertion for obstructive colorectal cancer: comparison with emergency operation.

Abstract

Expandable metallic stent endoprosthesis for preoperative "bridge to surgery" treatment of obstructive colorectal cancer has been broadly, clinically used with good short-term results. Stent insertion for malignant tumor, however, is controversial because of the increased risk of metastasis, invasion, and advancement of the cancer. We, first in the world, evaluated the long-term prognosis of expandable metallic stent insertion compared with emergency surgery without expandable metallic stent. Forty emergency operations (1986-1996) and 44 expandable metallic stent insertions (1993-2001) were retrospectively compared by history, duration, morbidity, and cumulative survival rate. There was no significant difference in age or lesion between the two groups. Postoperative complications were significantly less frequent in the expandable metallic stent group: wound infection was 14 vs. 2 percent; leakage following to anastomosis was 11 vs. 3 percent. Long-term prognosis did not significantly differ: three-year overall survival rate was 50 vs. 48 percent; five-year survival rate was 44 vs. 40 percent in the emergency operation and expandable metallic stent groups, respectively. Because preoperative expandable metallic stent insertion for obstructive colorectal cancer had good postoperative results and no disadvantages in long-term prognosis, this procedure should be used in preoperative treatments of obstructive colorectal cancer.