Abstract
Purpose: In Japan, self-expandable metallic stent (SEMS) for colorectal obstruction, which has been covered by national insurance since January 2012, has become rapidly common as a promising alternative to emergency surgery, as a bridge to surgery (BTS) approach. To examine the advantages of SEMS BTS, we compared short-term clinical outcomes of patients receiving preoperative SEMS placement with those of patients who were managed by preoperative lavage using a trans-anal ileus tube. Methods: Between 2011 and 2015, 36 patients who underwent surgery for obstructive colorectal cancer were retrospectively identified in our hospital. We divided them into two groups depending on procedures for preoperative bowel decompression; 24 cases receiving SEMS insertion (S group) and 12 cases receiving trans-anal ileus tube placement (I group), and weighed both groups as follows. Results: In the S group, all of the patients were allowed oral nutrition, thereby 75% of them could leave the hospital and have preoperative examinations as outpatients. Additionally, they showed significantly better outcomes in terms of the rate of preoperative body weight loss and the effect of bowel decompression when compared with the I group. Microscopically, mechanical crushing induced by SEMS occurred chiefly in the mucosal and submucosal layer but not the proper muscular layer. There was no significant difference in the degree of lymphovascular invasion between the two groups. Conclusion: SEMS insertion allowed the patients to undergo surgery under better conditions without causing adverse effects on lymphovascular invasion.
