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Background <p>The optimal management of stage IV colorectal cancer with malignant large bowel obstruction remains controversial. Self-expandable metallic stents are an established bridge to surgery in non-metastatic disease, but the role of primary tumor resection after stent placement in stage IV patients is unresolved. We propose and evaluate a “quasi-bridge to surgery” (Quasi-BTS) strategy in which stenting serves as a biological selection tool to identify patients who may benefit from delayed primary tumor resection.</p> Methods <p>This single-center retrospective cohort study analyzed consecutive stage IV obstructive colorectal cancer patients who underwent successful self-expandable metallic stent placement between January 2007 and December 2023. Patients were categorized into a Quasi-BTS group (delayed primary tumor resection), a palliative chemotherapy-only group, and palliative care-only group. Primary outcomes were overall survival, stent-related complications, and stoma-free survival.</p> Results <p>Fifty-three patients were analyzed (Quasi-BTS, <i>n</i> = 16; palliative chemotherapy only, <i>n</i> = 22; palliative care only, <i>n</i> = 15). The Quasi-BTS group had zero overall stent-related complications versus 46.7% and 36.4% in the palliative care-only and palliative chemotherapy-only groups, respectively (<i>P</i> = 0.009); perforation alone was a non-significant trend (0% vs. 26.7% vs. 27.3%, <i>P</i> = 0.070). The laparoscopic surgery rate was 82%, the primary anastomosis rate was 92%, and bevacizumab was safely administered in all 6 patients who received it. Overall survival was significantly longer in the Quasi-BTS group than in either palliative group (log-rank all <i>P</i> &lt; 0.001). After multivariable Cox adjustment for age, ASA, metastatic site, and targeted-therapy use, the Quasi-BTS group retained a markedly reduced hazard of death (adjusted HR 0.037, 95% CI 0.010–0.135). The mean interval from stent insertion to resection was 21.2 days in the resection-first subgroup.</p> Conclusions <p>The Quasi-BTS strategy may extend the bridge-to-surgery concept to metastatic colorectal cancer by repurposing stenting as a bridge for patient selection. Performing primary tumor resection within approximately three months of stent insertion was associated with the absence of stent-related complications in our cohort, appears to permit the subsequent use of anti-angiogenic targeted therapy without observed stent-related complications, and was associated with improved long-term survival.</p>

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A quasi-bridge to surgery approach for stage IV obstructive colon cancer: extending the bridge-to-surgery concept to metastatic disease

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月9日

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  • Shu-Huan Huang,
  • Sum-Fu Chiang,
  • Kun-Yu Tsai,
  • Pao-Shiu Hsieh,
  • Jeng-Fu You,
  • Cheng-Chou Lai

摘要

Background

The optimal management of stage IV colorectal cancer with malignant large bowel obstruction remains controversial. Self-expandable metallic stents are an established bridge to surgery in non-metastatic disease, but the role of primary tumor resection after stent placement in stage IV patients is unresolved. We propose and evaluate a “quasi-bridge to surgery” (Quasi-BTS) strategy in which stenting serves as a biological selection tool to identify patients who may benefit from delayed primary tumor resection.

Methods

This single-center retrospective cohort study analyzed consecutive stage IV obstructive colorectal cancer patients who underwent successful self-expandable metallic stent placement between January 2007 and December 2023. Patients were categorized into a Quasi-BTS group (delayed primary tumor resection), a palliative chemotherapy-only group, and palliative care-only group. Primary outcomes were overall survival, stent-related complications, and stoma-free survival.

Results

Fifty-three patients were analyzed (Quasi-BTS, n = 16; palliative chemotherapy only, n = 22; palliative care only, n = 15). The Quasi-BTS group had zero overall stent-related complications versus 46.7% and 36.4% in the palliative care-only and palliative chemotherapy-only groups, respectively (P = 0.009); perforation alone was a non-significant trend (0% vs. 26.7% vs. 27.3%, P = 0.070). The laparoscopic surgery rate was 82%, the primary anastomosis rate was 92%, and bevacizumab was safely administered in all 6 patients who received it. Overall survival was significantly longer in the Quasi-BTS group than in either palliative group (log-rank all P < 0.001). After multivariable Cox adjustment for age, ASA, metastatic site, and targeted-therapy use, the Quasi-BTS group retained a markedly reduced hazard of death (adjusted HR 0.037, 95% CI 0.010–0.135). The mean interval from stent insertion to resection was 21.2 days in the resection-first subgroup.

Conclusions

The Quasi-BTS strategy may extend the bridge-to-surgery concept to metastatic colorectal cancer by repurposing stenting as a bridge for patient selection. Performing primary tumor resection within approximately three months of stent insertion was associated with the absence of stent-related complications in our cohort, appears to permit the subsequent use of anti-angiogenic targeted therapy without observed stent-related complications, and was associated with improved long-term survival.