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World J Clin Oncol. Dec 24, 2022; 13(12): 957-966
Published online Dec 24, 2022. doi: 10.5306/wjco.v13.i12.957
Colonic stent for bridge to surgery for acute left-sided malignant colonic obstruction: A review of the literature after 2020
Margherita Binetti, Augusto Lauro, Valeria Tonini
Margherita Binetti, Valeria Tonini, Department of Medical and Surgical Sciences, University of Bologna, Alma mater Studiorum, Bologna 40138, Italy
Augusto Lauro, Department of Medical and Surgical Sciences, Sapienza University, Roma 324-00161, Italy
Author contributions: Binetti M analyzed the data and wrote the manuscript; Lauro A contributed to designing the research; Tonini V analyzed and corrected the manuscript; all authors contributed to this work; All authors have read and approved the final manuscript.
Conflict-of-interest statement: All authors report having no relevant conflicts of interest for this article.
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: Valeria Tonini, MD, Academic Research, Surgeon, Surgical Oncologist, Department of Medical and Surgical Sciences, University of Bologna, Alma mater Studiorum, Via Massarenti 9, Bologna 40138, Italy. valeria.tonini@unibo.it
Received: September 17, 2022
Peer-review started: September 17, 2022
First decision: October 21, 2022
Revised: October 31, 2022
Accepted: December 6, 2022
Article in press: December 6, 2022
Published online: December 24, 2022
Abstract

It has been found that 8%-29% of colorectal cancers are obstructive. The use of “stent as bridge to surgery” is one of the most debated topics in obstructive left-sided colorectal cancer management. The endoscopic placement of a self-expanding metallic stent as bridge to surgery (BTS) could turn an emergency surgery to an elective one, increasing the number of primary anastomoses instead of stoma and facilitating the laparoscopic approach instead of an open one. However, in recent years the possible risk of perforations and microperforations facilitating cancer spread related to the use of self-expanding metallic stent for BTS has been highlighted. Therefore, despite the useful short-term outcomes related to BTS, the recent literature has focused on long-term outcomes investigating the disease-free survival, the recurrence rate and the overall survival. Due to discordant data, international guidelines are still conflicting, and the debate is still open. There is not agreement about using self-expanding metallic stent for BTS as the gold standard.

Keywords: Colorectal cancer obstruction, Anastomosis, Laparoscopy, Recurrence rate, Overall survival, Guidelines

Core Tip: The most recent articles (published after 2020) about self-expanding metallic stent as bridge to surgery in left-sided colorectal cancer obstruction were collected. Both the short-term and long-term outcomes were analyzed, focusing on the role of stent-related microperforations in worsening disease-free and overall survival rates. Despite the growing number of studies published in recent years, the use of self-expanding metallic stent as bridge to surgery is not considered the gold standard due to conflicting reports. Updating meta-analyses, randomized studies and reviews will help determine new international guidelines and a shared treatment flow-chart.