Clinicopathologic Features of Self-expandable-metallic Stent for Left-sided Obstructive Colorectal Cancer

Area of Science:

• Gastroenterology and Hepatology
• Surgical Oncology
• Colorectal Surgery

Background:

• Obstructive colorectal cancer (OCRC) necessitates timely decompression to manage bowel obstruction.
• Two primary decompression techniques are trans-anal decompression tube (TADT) and self-expandable metallic stent (SEMS).
• Comparative analysis of their clinical and histological impacts is crucial for optimizing patient outcomes.

Purpose of the Study:

• To compare the clinical and histological characteristics of TADT versus SEMS in OCRC management.
• To evaluate decompression success rates, complication profiles, surgical outcomes, and patient prognosis.

Main Methods:

• Retrospective analysis of 96 OCRC patients undergoing decompression between 2000-2020.
• Patients were divided into TADT (n=44) and SEMS (n=52) groups.
• Comparison of technical success, complications, surgical parameters (laparoscopy, D3 dissection, lymph node yield), and survival rates (5-year overall and recurrence-free survival).

Main Results:

• High technical success rates for both TADT and SEMS.
• SEMS group demonstrated significant advantages in laparoscopic procedures, D3 dissection, and lymph node retrieval.
• Multivariate analysis linked lymphatic invasion to decompression, while SEMS showed association with reduced venous invasion. Recurrence-free survival was significantly better in the SEMS group (85.0% vs. 58.3%, p=0.04).

Conclusions:

• Self-expandable metallic stents (SEMS) show a potential histological advantage over trans-anal decompression tubes (TADT) in obstructive colorectal cancer.
• The improved recurrence-free survival in the SEMS group warrants consideration for its use in OCRC management.
• Further research may elucidate the specific mechanisms behind SEMS' superior performance regarding recurrence.