Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Mar 15, 2019; 11(3): 264-269
Published online Mar 15, 2019. doi: 10.4251/wjgo.v11.i3.264
Stent placement followed by preoperative chemotherapy and elective surgery for acute malignant colorectal obstruction: Six cases of report
Jun-Jie Liu, Teng-Hui Ma, Qi-Yuan Qin, Lei Wang
Jun-Jie Liu, Teng-Hui Ma, Qi-Yuan Qin, Lei Wang, Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
Author contributions: Wang L and Ma TH designed the study; Liu JJ and Qin QY collected the patients’ clinical data; Liu JJ wrote the paper; Wang L, Ma TH and Qin QY revised the paper.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the Sixth Affiliated Hospital of Sun Yat-sen University.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The guidelines of the CARE Checklist (2016) have been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Lei Wang, MD, PhD, Doctor, Professor, Surgeon, Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University, 26 Yuancun Erheng Road, Guangzhou 510655, Guangdong Province, China. wangl9@mail.sysu.edu.cn
Telephone: +86-020-38254052 Fax: +86-020-38254000
Received: October 13, 2018
Peer-review started: October 15, 2018
First decision: October 25, 2018
Revised: December 18, 2018
Accepted: January 8, 2019
Article in press: January 9, 2019
Published online: March 15, 2019
Processing time: 153 Days and 15 Hours
Abstract
BACKGROUND

The self-expandable metal stent is used as a bridge to surgery in the treatment of acute malignant colorectal obstruction (AMCO). However, recent studies have shown inferior long-term outcomes and increased risk of tumor dissemination after stent placement. In addition, the optimal interval between stent placement and surgery is not clear. The aim of the current study was to present a new strategy for AMCO: stent placement followed by preoperative chemotherapy and elective surgery.

CASE SUMMARY

Six patients were diagnosed as acute obstruction. There was one patient with descending cancer, four with sigmoid cancers and one with rectal cancer. The obstructive symptoms of these six patients were relieved within 3 d after stent placement. After receiving two cycles of preoperative chemotherapy, consisting of modified infusional fluorouracil, leucovorin and oxaliplatin [modified FOLFOX6 (mFOLFOX6)], they underwent elective surgery of primary tumor resection. None of the 6 patients received colostomy or colonic lavage during surgery. There was no complication of anastomotic leak, ileus or surgical site infection after surgery. In addition, the patients had low operation time and blood loss, adequate lymph nodes harvest and fast postoperative recovery.

CONCLUSION

The two-cycle mFOLFOX6 preoperative chemotherapy and elective surgery after stent placement is a safe and feasible strategy in the management of AMCO.

Keywords: Stent; Colorectal cancer; Obstruction; Preoperative chemotherapy; Case report

Core tip: The favorable short-term outcomes of stent placement, as a bridge to surgery for acute malignant colorectal obstruction, have been well described comparing with emergency surgery. However, the risk of tumor dissemination after stent placement is still a topic of concern. In addition, the current interval between stent placement and surgery is inadequate for the patient’s recovery and primary anastomosis. This study is to present the strategy of arranging two cycles of preoperative chemotherapy between stent placement and elective surgery for obstructive colorectal cancers. The six cases of patients showed no stoma creations and no adverse events.