Stent performance in obstructive left colon cancer. Unicentric and cross-sectional study

Area of Science:

• Gastroenterology
• Surgical Oncology
• Interventional Endoscopy

Background:

• Obstructive left colon cancer presents significant management challenges.
• Colonic stenting is an emerging therapeutic option for such cases.

Purpose of the Study:

• To assess the efficacy and safety of colonic stents as an initial treatment for obstructive left colon cancer.
• To evaluate clinical and oncological outcomes, including comparison between elective and urgent surgical approaches.

Main Methods:

• An ambispective study (2008-2018) included 208 patients with neoplastic obstruction of the left colon.
• Patients were analyzed based on stent indication: palliative, bridge to surgery, or stent failure/complications requiring urgent surgery.

Main Results:

• Technical and clinical success rates for colonic stenting were 82.2% and 74.5%, respectively, with a 4.3% perforation rate.
• 32.2% of patients had stents as a bridge to surgery, while 28.4% required urgent surgery due to failure or complications.
• Elective surgery after stenting showed better oncological resection, shorter hospital stays, and reduced morbidity/mortality compared to urgent surgery. Stage II-III patients undergoing elective surgery had improved survival.

Conclusions:

• Colonic stenting is an effective initial strategy for neoplastic left colon obstruction, facilitating elective surgery and potentially avoiding permanent colostomy in palliative settings.
• Complications or stent failure can lead to urgent surgery in a significant proportion of patients (nearly one-third).
• Stenting enables improved outcomes for patients selected for elective surgery, highlighting its role in optimizing treatment pathways.