The optimal surgical time after stent placement in obstructive colorectal cancer: impact on long-term survival of patients

Objective To investigate the optimal interval between self-expanding metal stent (SEMS) placement and radical surgery in patients with obstructive colorectal cancer. Method In this study, a retrospective research design was used to select 125 patients with obstructive colorectal cancer who underwent colonoscopic SEMS placement with subsequent radical surgery between February 2011 and November 2022 at Shanghai Changhai Hospital. In addition, their clinical data and therapeutic efficacy were examined. Grouping: grouping on the basis of the interval of bridge to surgery (BTS). Group A: interval of BTS <= 14 days; group B: 14 days < interval of BTS <= 21 days; group C1: interval of BTS > 21 days; group C2: interval of BTS > 21 days, excluding patients who received neoadjuvant therapy; group D: patients who received neoadjuvant therapy. Patients were grouped according to their different surgical methods, group E: patients who received open surgery and group F: patients undergoing laparoscopic surgery. Results A total of 125 patients were included in this study, the mean age of the patients was 61.34 +/- 13.99 years, with the median follow-up time was 39 (25-61) months. Of these, 84 cases (67.2%) underwent open surgery, while 41 cases (32.8%) underwent laparoscopic surgery. Among the cohort, 15 patients received neoadjuvant radiotherapy and chemotherapy after placement of SEMS. There was a significant difference in preoperative hemoglobin levels between group A and both group B and group C1. The laparoscopic surgery rate was significantly higher in group B than in the other two groups (48.57% versus 3.33% and 22.81%, P = 0.038). The 5-year disease-free survival (DFS) of group C1 patients was lower than that in group A and group B (32.4% versus 56.3%, 62.3%, P = 0.038; P = 0.043), whereas there was no statistical difference in the 5-year overall survival (OS) (60.7% versus 62.1%, 69.6%, P = 0.365, P = 0.339). group D showed a higher proportion of open surgery and a higher T-stage (P < 0.05), resulting in a 5-year DFS that was inferior to group A and group B (17.7% versus 56.3%, 62.3%, P = 0.045; P = 0.047). However, there was no significant difference compared with group C2 (17.7% versus 36.9%, P > 0.05). The 5-year OS of group D was not statistically significantly different from that of group A, group B, and group C2 (28.4% versus 62.1%, 69.6%, 73.4%, P = 0.089, P = 0.090, P = 0.183). In addition, no statistically significant differences were identified in 5-year DFS (49.9% versus 37.0%, P = 0.555) or 5-year OS (66.2% versus 62.6%, P = 0.062) between group E and group F Conclusions Radical surgery performed 14-21 days apart after SEMS placement has been shown to improve minimally invasive rates and 5-year DFS rates. The addition of neoadjuvant radiotherapy and chemotherapy during the interval does not appear to improve long-term survival, although this conclusion is based on the results of only 15 patients.