Self-Expanding Metallic Stent as a Bridge to Surgery in the Treatment of Left Colon Cancer Obstruction: Cost–Benefit Analysis and Oncologic Results

Introduction: The use of a self-expanding metallic stent as a bridge to surgery in acute malignant left colonic obstruction has been suggested as an alternative treatment to emergency surgery. The aim of the present study was to compare the morbi-mortality, cost-benefit and long-term oncological outcomes of both therapeutic options. Methods: This is a prospective, comparative, controlled, non-randomized study (2005-2010) performed in a specialized unit. The study included 82 patients with left colon cancer obstruction treated by stent as a bridge to surgery (n = 27) or emergency surgery (n = 55) operated with local curative intention. The main outcome measures (postoperative morbimortaliy, cost-benefit, stoma rate and long-term oncological outcomes) were compared based on an "intention-to-treat'' analysis. Results: There were no significant statistical differences between the two groups in terms of preoperative data and tumor characteristics. The technically successful stenting rate was 88.9% (11.1% perforation during stent placement) and clinical success was 81.4%. No difference was observed in postoperative morbi-mortality rates. The primary anastomosis rate was higher in the bridge to surgery group compared to the emergency surgery group (77.8% vs. 56.4%; P =.05). The mean costs in the emergency surgery group resulted to be (Sic)1,391.9 more expensive per patient than in the bridge to surgery group. There was no significant statistical difference in oncological long-term outcomes. Conclusions: The use of self-expanding metalllic stents as a bridge to surgery is a safe option in the urgent treatment of obstructive left colon cancer, with similar short and long-term results compared to direct surgery, inferior mean costs and a higher rate of primary anastomosis. (C) 2017 AEC. Published by Elsevier Espanna, S.L.U. All rights reserved.