title: Does Stenting as a Bridge to Surgery in Left-Sided Colorectal Cancer Obstruction Really Worsen Oncological Outcomes?
abstract: BACKGROUND
  Although self-expandable metal stents are used as a bridge to surgery in patients with colorectal cancer obstruction, their long-term oncological outcomes are unclear.
  
  
  OBJECTIVE
  The aim of this study was to investigate long-term oncological outcomes of self-expandable metal stents as a bridge to surgery (stent group) compared with direct surgery (direct operation group) in patients with left-sided colorectal cancer obstruction.
  
  
  METHODS
  This was a retrospective chart review.
  
  
  METHODS
  This study was conducted at a single tertiary academic center.
  
  
  METHODS
  Of 113 patients who underwent curative surgery for left-sided colorectal cancer obstruction at Asan Medical Center between 2005 and 2011, 42 underwent direct surgery and 71 underwent self-expandable metal stent insertion followed by elective surgery. After 1:1 propensity-score matching, 42 patients were enrolled in both groups, and their postsurgical outcomes were compared.
  
  
  METHODS
  The primary outcomes of this study were long-term oncological outcomes, including overall survival and recurrence-free survival of patients in both groups.
  
  
  RESULTS
  Three- and 5-year overall survival rates were similar in the stent (87.0% and 71.0%) and direct operation (76.4% and 76.4%) groups (p = 0.931). Three- and 5-year recurrence-free survival rates were also similar in the stent (91.9% and 66.4%) and direct operation (81.2% and 71.2%) groups (p = 0.581), as were postsurgical complication rates (9.5% and 16.7%; p = 0.344). No patient in either group experienced a permanent stoma.
  
  
  CONCLUSIONS
  This study was limited by its small patient numbers and retrospective nature.
  
  
  CONCLUSIONS
  The long-term oncological outcomes of self-expandable metal stents as a bridge to surgery may not be inferior to those of direct surgery for left-sided colorectal cancer obstruction.
authors.affiliation: 1 Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea 2 Department of Colon and Rectal Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Min Seob
authors.initials: MS
authors.lastname: Kwak
authors.forename: Wan Soo
authors.initials: WS
authors.lastname: Kim
authors.forename: Jeong-Mi
authors.initials: JM
authors.lastname: Lee
authors.forename: Dong-Hoon
authors.initials: DH
authors.lastname: Yang
authors.forename: Yong Sik
authors.initials: YS
authors.lastname: Yoon
authors.forename: Chang Sik
authors.initials: CS
authors.lastname: Yu
authors.forename: Jin Cheon
authors.initials: JC
authors.lastname: Kim
authors.forename: Jeong-Sik
authors.initials: JS
authors.lastname: Byeon
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D003131:Combined Modality Therapy; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D000069322:Self Expandable Metallic Stents / Q000009:adverse effects*; D016019:Survival Analysis; D016896:Treatment Outcome