Beyond Obstruction: Evaluating Self-Expandable Metallic Stents (SEMSs) vs. Emergency Surgery for Challenging pT4...

Area of Science:

• Gastroenterology
• Surgical Oncology
• Medical Devices

Background:

• Colon cancer obstruction affects nearly 30% of patients.
• Self-expandable metallic stents (SEMS) are an alternative to emergency surgery for malignant colonic obstruction.
• SEMS use is increasingly incorporated into clinical guidelines due to improved techniques.

Purpose of the Study:

• To compare colectomies after SEMS insertion versus emergency surgery for pT4 obstructive left colon cancer.
• To analyze and compare postoperative and oncological outcomes between the two treatment groups.

Main Methods:

• Observational retrospective multicenter study (50 hospitals) of patients with pT4 obstructive left colon cancer treated with curative intent (2015-2017).
• Exclusion criteria: palliative surgery or incomplete resection.
• Primary outcomes: recurrence rates (local, peritoneal, systemic), overall survival (OS), disease-free survival (DFS). Secondary outcomes: postoperative complications, rate of surgeries without major complications.

Main Results:

• 196 patients analyzed: 128 emergency surgery, 68 SEMS.
• SEMS group had higher rates of minimally invasive surgery (33.8% vs 4.7%, p < 0.01).
• SEMS group showed significantly fewer major complications (4.5% vs 22.4%, p < 0.01) and organ-space infections (3.3% vs 15.9%, p = 0.03). No significant differences in recurrence rates or survival (OS, DFS) were observed.

Conclusions:

• SEMS are a safe and effective alternative for pT4 obstructive left colon cancer.
• SEMS improve postoperative outcomes without compromising short- to medium-term oncological results.
• Referral to experienced centers with advanced stenting capabilities may optimize patient care.