Endoscopic Stenting Does Not Worsen Long Term Outcomes Amongst Patients Presenting with Obstruction from Colorectal Cancers.

BACKGROUND: Stenting has been increasingly adopted in colorectal cancer patients presenting with acute large bowel obstruction. However, long-term outcomes of stenting are lacking in the literature. Our study attempts to compare the long-term outcomes of colonic stenting and emergency surgery amongst left-sided colorectal cancer patients presenting with acute large bowel obstruction.

METHODS: A retrospective review of all patients who presented with nonmetastatic colorectal cancer who underwent either endoscopic stenting or emergency surgery for acute large bowel obstruction was performed from January 2007 to April 2016. Patients were analysed in an intention-to-treat analysis.

RESULTS: Forty-seven (46.1%) patients underwent emergency surgery, whereas 55 (53.9%) underwent colonic stenting with a technical success rate of 71.0%. Patients who underwent emergency surgery were more likely to develop severe complications compared with patients who underwent successful colonic stenting, but the difference was not statistically significant (odds ratio [OR] 2.84; 95% confidence interval [CI] 0.71-11.3, p = 0.139). Patients were followed up for a median of 48.3 months (3.1-111) in the stenting group and 51.2 months (1.2-117.1) in the emergency surgery group. Recurrence rates between colonic stenting and emergency surgery were similar (25.6% vs. 21.3%, p = 0.500), with more anastomotic and peritoneal recurrences were noted in the emergency surgery group. 5 year disease free survival (77% vs. 73%, p = 0.708) and overall survival (86% vs. 62%, p = 0.064) also were similar.

CONCLUSIONS: Patients who underwent endoscopic stenting for large bowel obstruction have comparable long-term outcomes as those who undergo emergency surgery. The role of endoscopic stenting in obstructed colorectal cancers merits further evaluation.