Study on long-term prognosis of patients with completely obstructive left-sided colon cancer treated with self-expanding metallic stents combined with neoadjuvant chemotherapy

SHI Yang; ZHAI Zhi-wei; YU Jian-feng; CAO Ke; YE Chun-xiang; WU Yun-long; YAO Jian-nan; MA Lian-gang; LI Zhu-lin; QU Hao; WANG Zhen-jun; HAN Jia-gang

doi:10.19538/j.cjps.issn1005-2208.2024.07.18

Abstract：Objective To investigate the long-term efficacy of self-expanding metallic stents(SEMS)combined with neoadjuvant chemotherapy in the treatment of completely obstructive left-sided colon cancer.Methods A retrospective analysis was conducted based on the clinical data of 82 patients with completely obstructive left-sided colon cancer treated at the Department of General Surgery,Beijing Chaoyang Hospital,Capital Medical University between January 2014 and May 2023.Based on the treatment regimen,the patients were divided into two groups.Stent-Surgery Group(Stent Group,n=35):patients received SEMS to relieve acute obstruction followed by curative surgery after stabilization.Stent-Neoadjuvant Chemotherapy-Surgery Group(Stent-Neoadjuvant Group,n=47):patients received SEMS to relieve acute obstruction followed by neoadjuvant chemotherapy during waiting period and then curative surgery.The primary outcome measures were overall survival(OS)and disease-free survival(DFS).Results All patients were followed up,with a median follow-up time of 55 months(range 12-112 months).Compared with the Stent Group,the Stent-Neoadjuvant Group had a significantly higher proportion of laparoscopic surgeries(89.4％vs.65.7％,P=0.007),a significantly lower stoma rate(10.6％vs.28.6％,P=0.038),an increase in the number of lymph nodes detected(30.3±16.0 vs.23.0±10.0,P=0.021),while there was no significant difference in the number of positive lymph nodes detected between groups(0[0-2.0]vs.0.5[0-3.0],P=0.513).The 3-year OS(85.2％vs.60.0％,P=0.035),3-year DFS(81.5％vs.50.0％,P=0.013),5-year OS(78.3％vs.51.7％,P=0.048),and 5-year DFS(73.9％vs.41.4％,P=0.019)in the Stent-Neoadjuvant Group were all significantly better than that in the Stent Group.The 5-year local recurrence rate(2.1％vs.14.3％,P=0.037)and distant metastasis rate(12.8％vs.34.3％,P=0.020)in the Stent-Neoadjuvant Group were significantly lower than that in the Stent Group.Cox regression analysis indicated that the treatment approach(stent-surgery)was an independent risk factor affecting OS(HR=2.42,95％CI 1.07-5.49,P=0.034)and DFS(HR=3.17,95％CI 1.30-7.76,P=0.011)in patients with obstructive left-sided colon cancer.Conclusion The combination of SEMS and neoadjuvant chemotherapy significantly improves the long-term survival of patients with obstructive left-sided colon cancer and reduces the risk of postoperative local recurrence and distant metastasis.