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Treatment outcome of laparoscopic surgery after self-expandable metallic stent insertion for obstructive colorectal cancer

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Abstract

Background

We assessed the technical and oncological safety of self-expandable metallic stent (SEMS) insertion followed by laparoscopic colorectal surgery as a bridge to surgery (BTS) for obstructive colorectal cancer (CRC).

Methods

A retrospective, single-center study analyzed the short- and long-term outcomes of SEMS insertion followed by laparoscopic colorectal surgery in patients with stage II/III/IV obstructive CRC from 2012 to 2020 at Cancer Institute Hospital.

Results

In 66 patients, including 28 stage IV patients, the clinical success rates of SEMS insertion were 97%. In laparoscopic surgery, primary anastomosis was performed in 61 patients (92%), and open conversion was required in 2 patients (3%). Postoperative complications were seen in 9 patients (13%); however, there was no anastomotic leakage or mortality. Curative resection was achieved in all 38 stage II/III patients and 15 of 28 (54%) stage IV patients. Stage IV patients had a longer operation time and greater blood loss than stage II/III patients; however, the open conversion and postoperative complication rates were similar between the groups. In stage II/III patients, 3-year disease-free survival and 3-year overall survival [OS] were 87.1 and 89.5%, respectively. The median OS of stage IV patients was 34.9 months, and stage IV patients who underwent R0 resection showed a significantly better OS (P = 0.0011) than those with R2 resection.

Conclusion

SEMS insertion followed by laparoscopic surgery is a feasible treatment strategy that achieves a high-primary anastomosis rate without severe postoperative complication in not only stage II/III but also stage IV obstructive CRC patients.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Gastroenterological Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Yukiharu Hiyoshi, Toshiki Mukai, Toshiya Nagasaki, Tomohiro Yamaguchi, Satoshi Nagayama, Takashi Akiyoshi & Yosuke Fukunaga

  2. Department of Hepato-Biliary-Pancreatic Medicine, Gastroenterological Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan

    Takashi Sasaki

  3. Department of Lower Gastrointestinal Medicine, Gastroenterological Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan

    Shoichi Saito

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  1. Yukiharu Hiyoshi
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  2. Toshiki Mukai
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Correspondence to Yukiharu Hiyoshi.

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Hiyoshi, Y., Mukai, T., Nagasaki, T. et al. Treatment outcome of laparoscopic surgery after self-expandable metallic stent insertion for obstructive colorectal cancer. Int J Clin Oncol 26, 2029–2036 (2021). https://doi.org/10.1007/s10147-021-01990-0

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  • DOI: https://doi.org/10.1007/s10147-021-01990-0

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