Abstract
Objectives: Self-expandable metallic stent (SEMS) therapy for malignant colorectal strictures has been covered by the national insurance in Japan since 2012. There has been a gradual increase in the use of bridge to surgery (BTS), in which a stent is inserted for obstructive colorectal cancer to avoid emergency surgery, following which elective surgery is performed. SEMS reportedly reduces the rate of postoperative complications compared to emergency surgery. Malnutrition is also known to be a risk factor for postoperative complications, however, few reports have assessed nutritional status with respect to obstructive colorectal cancer. Therefore, we retrospectively investigated changes in nutritional status and colorectal cancer treatment outcomes in BTS patients following SEMS placement for obstructive colorectal cancer.
Methods: Subjects included 33 BTS patients who underwent nutritional assessment before and after SEMS placement for obstructive colorectal cancer at Kawasaki Municipal Tama Hospital between January 2012 and December 2018. The indicators of nutritional status were prealbumin (PA) and the prognostic nutritional index (PNI). In addition to nutritional status, patient background, SEMS outcome, and postoperative results of BTS were examined. Regarding the postoperative results of BTS, nutritional status was compared with and without postoperative complications.
Results: In the group with postoperative complications, before SEMS placement and after SEMS placement PA didn’t differ significantly (P=0.603); and after SEMS placement PNI was significantly lower than before SEMS placement PNI (P=0.014). On the contrary, in the group without postoperative complications, PA after SEMS placement was significantly higher than that before SEMS placement (P=0.008); and PNI didn’t increased after SEMS placement (P=0.205).
Conclusions: In BTS patients with SEMS for obstructive colorectal cancer, PA may be a useful indicator of postoperative complications. PA and PNI demonstrated different manifestations related to SEMS as a BTS use for obstructive colorectal cancer, and improvement of PA may be useful as a predictor of postoperative course.
