Does Stenting Of Colorectal Cancer As A Bridge To Surgery For The Complete Obstruction Incerase The Rate Of Perineural Invasion?

Objective: Self-expandable metal stent(SEMS)insertion is considered to be an effective method for the treatment of acute malignant colonic obstruction(AMCO).However,the study on the long-term impact of SEMS as a "bridge to surgery" is limited and contradictory.Experts and scholars expressed concern about the long-term clinical results of oncology.The purpose of this study was to compare ten perineural invasion and long-term oncological outcomes between the two groups.Methods: The clinical data of the patients with acute intestinal obstruction caused by colorectal cancer from January 2013 to January 2018 were retrospectively collected.Forty-three patients underwent semielective curative resection after endoscopic SEMS insertion and Sixty-three underwent emergency surgery among them.The adverse events associated with stents,surgery,and long-term follow-up outcomes were collected,and the clinicopathological characteristics,perineural invasion rate and survival were compared between the two groups.Results:There were no significant differences in demographics,tumor stage,location,and histology between the SEMS and ES groups.Compared with the emergency operation group,the temporary stoma rate in ESMS group was significantly lower(32.6% VS46%;P = 0.03),and there was no significant difference in the permanent stoma rate between the two groups(P = 0.337).The hospital mortality in the SEMS group was 0% and that in the surgery group was 1.6%(P = 0.11).The average hospitalization time(12.65 +5.286 and 14.52 +7.20 D,P=0.01)and total hospitalization time(17.07 +5.544 and 20.48 +7.372 D,respectively,in the SEMS and ES groups)were significantly differences(P=0.042).The incidence of complications after emergency surgery increased significantly(11.6% and 28.6% P =0.038).Compared with ES group,there was no significant increase in neurological invasion(39.5% vs 47.6%,P = 0.411),and there was no significant difference between the two group.(39.5% vs 47.6%,P <=0.411).The proportions of patients who received postoperative adjuvant chemotherapy were comparable(46.5% in SEMS group and 33.3% in ES group;P=0.171).The follow-up time were 24 months(9-79months)for the SEMS group and 27 months(2-73 months)for the ES group.There was no significant difference in survival rate and long-term prognosis between the two groups.Conclusions:Preoperative colon stent insertion is an effective transitional method to elective surgery for patients with complete intestinal obstruction caused by colorectal cancer..Compared with the ES group,stent implantation did not increase the rate of perineural invasion,and there was no significant difference in the survival rate and ong-term oncological results.