Deniz ÖÇAL, Mehmet TORUN
Turkish Journal of Colorectal Disease - 2026;36(1):19-26
Aim: The aim of this retrospective cohort study was to evaluate the perioperative and long-term oncological outcomes of patients with malignant colonic obstruction who underwent self-expandable metallic stent (SEMS) implantation as a bridge to surgery (BTS), followed by elective laparoscopic colectomy. Method: One-hundred two consecutive patients initially managed with a SEMS implantation as a BTS constituted a modified intention-to-treat cohort and were retrospectively analyzed. Ninety-five of these patients (the per-protocol cohort) went on to undergo a resection with curative intent between 2013 and 2023 at a tertiary referral center. Clinical demographics, operative findings, pathological results, postoperative complications, and survival outcomes for all participants were systematically recorded. The primary endpoints were overall survival, laparoscopic completion rate, and R0 resection rate. Secondary endpoints included postoperative morbidity, anastomotic leakage, recurrence, distant metastasis, disease-free survival, metastasis-free survival, and stent-to-surgery interval. Median follow-up values were calculated using the reverse Kaplan-Meier method. Results: Stent placement was technically successful in all (95/95) patients in the operative (per-protocol) cohort. The mean interval between SEMS placement and surgery was 10+/-3 days. Laparoscopic resection was completed in 84.2% of these patients, whereas 15.8% required a conversion to open surgery. The mean operative time was 148+/-32 minutes, and intraoperative complications occurred in 4.2% of cases. An adequate lymphadenectomy count (>=12 nodes) was achieved in over 90% of patients, with a median lymph node yield of 21. The R0 resection rate was 93.7%. Postoperative complications, including anastomotic leakage, occurred in approximately 40% of patients, including both laparoscopic and open surgery cases. No 30-day mortality was observed. During the reverse Kaplan-Meier median follow-up period of 31.8 months, recurrence occurred in 28.4% of cases, and distant metastasis in 21.0%. The 3-year OS rate was 76%, with no significant difference between laparoscopic and open surgery procedures (p>0.05). Kaplan-Meier curves with number-at-risk tables support these findings. Conclusion: Endoscopic stenting, followed by elective laparoscopic colectomy, represents a feasible and clinically sound BTS strategy for malignant colonic obstruction. This approach provides acceptable perioperative outcomes, enables high rates of minimally invasive resection, and does not appear to negatively influence medium-term oncological outcomes in appropriately selected patients. Further prospective studies are needed to refine the patient selection process and validate the long-term oncologic safety of this approach.
