Does preoperative stent positioning in obstructive left sided colon cancer increase the risk of perineural invasion?

Colonic stenting as a bridge to surgery has been shown to be a safe and effective treatment for left-sided malignant colonic obstruction depending on local expertise. However, concerns still exist regarding its oncological safety. In particular, several reports showed an increased prevalence of perineural tumor invasion following stent placement. Since perineural invasion negatively affects oncological outcomes, the present study sought to evaluate this controversial association. We retrospectively reviewed 114 patients presenting with left-side obstructing colon cancer over a 10-year period. The relationship between perineural invasion and colonic stenting was analyzed using univariate and multivariate analyses. Perineural invasion was found to be strongly associated with pathological features, including TNM stage, (p < 0.001), poor differentiation (p = 0.002), vascular invasion (p < 0.001), lymphatic invasion (p < 0.001), whereas no significant association with preoperative stenting was observed (p = 0.918) after performing univariate analysis. In the multivariate model, only TNM stage III-IV (OR: 6.810, 95% CI 1.972-23.518, p = 0.002) and venous invasion (OR: 5.325, 95% CI 1.911-14.840, p = 0.001) were independently associated with perineural invasion. The results of this study suggest no association between preoperative colonic stenting and perineural invasion.