Short-term outcomes of self-expanding metallic stents and transanal colorectal tubes as a bridge to surgery for obstructive colon cancer: a nationwide retrospective study.

PURPOSE: Obstructive colorectal cancer has a poor prognosis. Self-expanding metallic stents (SEMSs) and transanal colorectal tubes (TCTs) are used as a bridge to surgery (BTS). However, comparative evidence is limited. This study compared the short-term outcomes of SEMS and TCT placement using a nationwide database.

METHODS

We identified 19,564 patients who underwent colectomy after SEMS or TCT placement for cT3-4N0-2M0 colon cancer between 2012 and 2022 using the Diagnosis Procedure Combination database. After exclusion, 16,033 patients were analyzed. Propensity score matching generated 5,203 matched pairs for analysis. Outcomes were compared using conditional logistic regression and linear fixed-effect models.

RESULTS

The overall stoma rate was significantly lower in the SEMS group than in the TCT group (odds ratio [OR], 0.29; 95% confidence interval [CI], 0.23-0.35). SEMS placement was associated with reduced postoperative abdominal drainage (OR, 0.31; 95% CI, 0.28-0.35) and reoperation (OR, 0.25; 95% CI, 0.20-0.31) rates. The total hospital stay was shorter in the SEMS group (regression coefficient, - 3.5 days; 95%CI, - 4.3 to - 2.6).

CONCLUSIONS

This nationwide cohort study showed that SEMS placement significantly reduced perioperative stoma construction compared with TCT placement. A lower frequency of stoma construction, postoperative abdominal drainage, and reoperation was associated with shorter total hospital stays.