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Background and aims <p>Self-expandable metal stents (SEMS) are effective in alleviating malignant colorectal obstruction. However, bowel perforation following SEMS placement remains a significant concern, as it can adversely affect oncological outcomes. This study aimed to evaluate the recurrence and overall survival rates associated with SEMS-related bowel perforations.</p> Methods <p>This multicenter, retrospective analysis included patients with obstructive colorectal cancer who underwent SEMS placement as a bridge to surgery. The data collection period spanned from January 2008 to May 2019, with patient matching in a 1:5 ratio based on age, sex, tumor location, pathological stage, and achievement of curative resection.</p> Results <p>Among the 412 patients who received SEMS placement, 25 (6.1%) patients experienced SEMS-related perforations (perforation group), with 21 instances classified as overt and four as silent perforations. Compared with 125 matched controls (non-perforation group), the perforation group showed elevated rates of emergent surgery, open surgery, and stoma formation, as well as a reduced interval from SEMS placement to surgery. The 5-year recurrence rate was notably higher in the perforation group than in the no-perforation group (47.4% vs. 21.5%, <i>p</i> &lt; 0.001), whereas the 5-year survival rate was not significantly different between groups (63.8% vs. 80.0%, <i>p</i> = 0.330).</p> Conclusions <p>SEMS-related perforation led to less favorable surgical outcomes and a higher rate of recurrence, although no notable impact on overall survival was observed. Considering the risk of perforation, these findings support the cautious use of SEMS as a bridge to surgery.</p>

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Impact of perforation following self-expandable metal stent as a bridge to surgery for malignant colorectal obstruction: a multicenter study of the Research Group for Stent in the Korean Society of Gastrointestinal Endoscopy

  • 期刊论文

  • 发表日期：

    2025年1月3日

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  • Han Hee Lee,
  • Dong Hyun Kim,
  • Hyun Lim,
  • Jung-Wook Kim,
  • Yunho Jung,
  • Hyun-Soo Kim,
  • Hyung-Hoon Oh,
  • Jin Won Kim,
  • Kwang Bum Cho,
  • Young-Eun Joo,
  • Bo-In Lee

摘要

Background and aims

Self-expandable metal stents (SEMS) are effective in alleviating malignant colorectal obstruction. However, bowel perforation following SEMS placement remains a significant concern, as it can adversely affect oncological outcomes. This study aimed to evaluate the recurrence and overall survival rates associated with SEMS-related bowel perforations.

Methods

This multicenter, retrospective analysis included patients with obstructive colorectal cancer who underwent SEMS placement as a bridge to surgery. The data collection period spanned from January 2008 to May 2019, with patient matching in a 1:5 ratio based on age, sex, tumor location, pathological stage, and achievement of curative resection.

Results

Among the 412 patients who received SEMS placement, 25 (6.1%) patients experienced SEMS-related perforations (perforation group), with 21 instances classified as overt and four as silent perforations. Compared with 125 matched controls (non-perforation group), the perforation group showed elevated rates of emergent surgery, open surgery, and stoma formation, as well as a reduced interval from SEMS placement to surgery. The 5-year recurrence rate was notably higher in the perforation group than in the no-perforation group (47.4% vs. 21.5%, p < 0.001), whereas the 5-year survival rate was not significantly different between groups (63.8% vs. 80.0%, p = 0.330).

Conclusions

SEMS-related perforation led to less favorable surgical outcomes and a higher rate of recurrence, although no notable impact on overall survival was observed. Considering the risk of perforation, these findings support the cautious use of SEMS as a bridge to surgery.