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

OBJECTIVES

We aimed to clarify the differences in clinical and histological characteristics between two decompression techniques for obstructive colorectal cancer (OCRC): trans-anal decompression tube (TADT) and self-expandable metallic stent (SEMS).

METHODS

Overall, 96 of 175 patients with OCRC treated in our department between 2000 and 2020, were assigned into TADT (n = 44) and SEMS (n = 52) groups, and the success rate and complications of decompression, surgical outcomes, clinicopathological findings, and prognosis were compared.

RESULTS

The technical success rate was high in all patients. During surgery, the SEMS group showed significant differences in laparoscopy (p < 0.01), D3 dissection (p < 0.001), and the number of lymph nodes dissected (p < 0.01). In multivariate analysis, lymphatic invasion was associated with decompression (odds ratio [OR], 5.49; 95% confidence interval [CI], 2.12-14.20; p < 0.01) and lymph node metastasis (OR, 4.44; 95% CI, 1.69-11.70; p < 0.01), while SEMS was associated with venous invasion (OR, 0.40; 95% CI, 0.16-0.98; p = 0.04). The 5-year and recurrence-free survival rates for 70 patients with stage II and III OCRC were 76.7% and 73.2%, respectively. Although there was no significant difference in the overall survival, the recurrence-free survival was significantly better in the SEMS group (85.0% vs. 58.3%, p = 0.04).

CONCLUSIONS

The results of this study suggest that SEMS may be preferable to TADT from a histological perspective.