Efficacy And Safety Analysis Of Self-expanding Metal Stents As Surgical Bridges For Right-sided Colonic Cancer Obstruction

Introduction:Self-expanding metal stent(SEMS)implantation has been widely used in left-sided colonic cancer obstruction,but there are few studies on self-expanding metal stent implantation in right-sided colonic cancer obstruction.This study aims to compare the effect of elective surgery after self-expanding metal stent implantation and emergency surgery(ES)in right-sided colonic cancer obstruction,to evaluate the efficacy and safety of self-expanding metal stent implantation in the treatment of right-sided colonic cancer obstruction.Methods:We retrospectively analyzed 95 patients admitted to our hospital from January2010 to December 2021 for right-sided colonic cancer obstruction surgery,and divided the patients into 2 groups,one group for elective surgery after stenting,i.e.,bridge to surgery(BTS)group,and the other group for emergency surgery.The chi-square test was used to compare the efficacy of the two groups,and patients were followed up to plot Kaplan-Meier survival curves.Results:Of the 95 eligible patients,35 underwent elective surgery after stent implantation and 60 underwent emergency surgery according to inclusion and exclusion criteria.The success rate of stent placement technique was 100%,with a clinical success rate of 88.6%.More vascular invasion was observed in the BTS group(13/35 [37.1] vs8/60 [13.3],p=0.007)as well as more positive lymph nodes could be obtained(median [IQR],1[0-3] vs 0[0-1],p=0.032).However,the length of hospital stays(median [IQR],17[14-19] vs 11[9-15.5],p=0.001)was longer than that in the ES group.There was no significant difference between the two groups in terms of postoperative complications(p=0.082)and postoperative mortality(p=1.000).More patients in the ES group received postoperative chemotherapy(8 of 35[22.9] vs 28 of60[46.7],p=0.021).Laparoscopic surgery was more likely to be performed in the BTS group(42.9%),and more cases of recurrence were observed in the ES group(11.7%).However,there was no significant difference in the choice of surgical method(p=0.104)or tumor recurrence(p=0.091)between the two groups.The 1-year overall survival rates(OS)were 91.4% and 88.3% for the BTS and ES groups,respectively,and the 3-years OS were 85.7% and 81.7%,respectively,and the 5-years OS were 82.9% and 76.7%,respectively,however,the two groups had no significant differences in 1-year OS(p=0.837),3-year OS(p=0.878),or 5-year OS(p=0.603).Conclusions:The vast majority of patients with right-sided colonic cancer obstruction underwent emergency resection.There was no significant difference between the two groups in terms of postoperative complications and mortality and 1-,3-,and 5-years overall survival.However,the BTS group was more likely to undergo laparoscopic surgery,and the success rate of stenting technique for right-sided colonic obstruction was high,therefore,this study concluded that stenting for right-sided colonic cancer obstruction was feasible.Due to the lack of high-level studies on the optimal management of right-sided colonic cancer obstruction and the technically challenging placement of right-sided colonic cancer obstruction stents,future research is warranted to develop clinical evidence-based guidelines.