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World J Clin Oncol. Dec 24, 2022; 13(12): 943-956
Published online Dec 24, 2022. doi: 10.5306/wjco.v13.i12.943
Oncologic safety of colonic stenting as a bridge to surgery in left-sided malignant colonic obstruction: Current evidence and prospects
Sukit Pattarajierapan, Nattapanee Sukphol, Karuna Junmitsakul, Supakij Khomvilai
Sukit Pattarajierapan, Nattapanee Sukphol, Karuna Junmitsakul, Supakij Khomvilai, Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
Author contributions: Pattarajierapan S wrote the article; Sukphol N, Junmitsakul K, and Khomvilai S made substantial contributions to the content, offered critical revisions, and approved the final version of the article.
Conflict-of-interest statement: Dr. Sukit Pattarajierapan, Nattapanee Sukphol, Karuna Junmitsakul and Supakij Khomvilai have no conflicts of interest or financial ties to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sukit Pattarajierapan, MD, Doctor, Surgeon, Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok 10330, Thailand. sukit.p@chulahospital.org
Received: September 2, 2022
Peer-review started: September 2, 2022
First decision: September 27, 2022
Revised: October 10, 2022
Accepted: December 8, 2022
Article in press: December 8, 2022
Published online: December 24, 2022
Processing time: 107 Days and 17.8 Hours
Abstract

Approximately 7%-29% of patients with colorectal cancer present with colonic obstruction. The concept of self-expandable metal stent (SEMS) insertion as a bridge to surgery (BTS) is appealing. However, concerns on colonic stenting possibly impairing oncologic outcomes have been raised. This study aimed to review current evidence on the short- and long-term oncologic outcomes of SEMS insertion as BTS for left-sided malignant colonic obstruction. For short-term outcomes, colonic stenting facilitates a laparoscopic approach, increases the likelihood of primary anastomosis without a stoma, and may decrease postoperative morbidity. However, SEMS-related perforation also increases local recurrence and impairs overall survival. Moreover, colonic stenting may cause negative oncologic outcomes even without perforation. SEMS can induce shear forces on the tumor, leading to increased circulating cancer cells and aggressive pathological characteristics, including perineural and lymphovascular invasion. The conflicting evidence has led to discordant guidelines. Well-designed collaborative studies that integrate both oncologic outcomes and data on basic research (e.g., alteration of circulating tumors) are needed to clarify the actual benefit of colonic stenting as BTS.

Keywords: Bridge to surgery; Colon cancer; Colorectal surgery; Emergency treatment; Intestinal obstruction; Self-expandable metal stent

Core Tip: Although the concept of self-expandable metal stent (SEMS) insertion as a bridge to surgery in patients with left-sided malignant colonic obstruction is promising, there remain concerns of adverse oncologic outcomes. Nowadays, three possible mechanisms of tumor dissemination from SEMS have been proposed: (1) SEMS-related perforation; (2) increased circulating tumor cells; and (3) aggressive pathological features after SEMS placement. However, among these, only SEMS-related perforation clearly influences adverse oncologic outcomes. The other two mechanisms lack consistent clinical evidence for their association with decreased survival. Therefore, further collaborating studies are needed to validate the clinical impact of these hypotheses.