To investigate the optimal interval between self-expanding metal stent (SEMS) placement and radical surgery in patients with obstructive colorectal cancer.

In this study, a retrospective research design was used to select 125 patients with obstructive colorectal cancer who underwent colonoscopic SEMS placement with subsequent radical surgery between February 2011 and November 2022 at Shanghai Changhai Hospital. In addition, their clinical data and therapeutic efficacy were examined. Grouping: grouping on the basis of the interval of bridge to surgery (BTS). Group A: interval of BTS ≤ 14 days; group B: 14 days < interval of BTS ≤ 21 days; group C1: interval of BTS > 21 days; group C2: interval of BTS > 21 days, excluding patients who received neoadjuvant therapy; group D: patients who received neoadjuvant therapy. Patients were grouped according to their different surgical methods, group E: patients who received open surgery and group F: patients undergoing laparoscopic surgery.

A total of 125 patients were included in this study, the mean age of the patients was 61.34 ± 13.99 years, with the median follow-up time was 39 (25-61) months. Of these, 84 cases (67.2%) underwent open surgery, while 41 cases (32.8%) underwent laparoscopic surgery. Among the cohort, 15 patients received neoadjuvant radiotherapy and chemotherapy after placement of SEMS. There was a significant difference in preoperative hemoglobin levels between group A and both group B and group C1. The laparoscopic surgery rate was significantly higher in group B than in the other two groups (48.57% versus 3.33% and 22.81%, P = 0.038). The 5-year disease-free survival (DFS) of group C1 patients was lower than that in group A and group B (32.4% versus 56.3%, 62.3%, P = 0.038; P = 0.043), whereas there was no statistical difference in the 5-year overall survival (OS) (60.7% versus 62.1%, 69.6%, P = 0.365, P = 0.339). group D showed a higher proportion of open surgery and a higher T-stage (P < 0.05), resulting in a 5-year DFS that was inferior to group A and group B (17.7% versus 56.3%, 62.3%, P = 0.045; P = 0.047). However, there was no significant difference compared with group C2 (17.7% versus 36.9%, P > 0.05). The 5-year OS of group D was not statistically significantly different from that of group A, group B, and group C2 (28.4% versus 62.1%, 69.6%, 73.4%, P = 0.089, P = 0.090, P = 0.183). In addition, no statistically significant differences were identified in 5-year DFS (49.9% versus 37.0%, P = 0.555) or 5-year OS (66.2% versus 62.6%, P = 0.062) between group E and group F CONCLUSIONS: Radical surgery performed 14-21 days apart after SEMS placement has been shown to improve minimally invasive rates and 5-year DFS rates. The addition of neoadjuvant radiotherapy and chemotherapy during the interval does not appear to improve long-term survival, although this conclusion is based on the results of only 15 patients.

Anastomotic stricture significantly impacts patients' quality of life and long-term prognosis. However, current clinical practice lacks accurate tools for predicting anastomotic stricture. This study aimed to develop a nomogram to predict anastomotic stricture in patients with rectal cancer who have undergone anterior resection.

A total of 1542 eligible patients were recruited for the study. Least absolute shrinkage selection operator (Lasso) analysis was used to preliminarily select predictors. A prediction model was constructed using multivariate logistic regression and presented as a nomogram. The performance of the nomogram was evaluated using receiver operating characteristic (ROC) curves, calibration diagrams, and decision curve analysis (DCA). Internal validation was conducted by assessing the model's performance on a validation cohort.

72 (4.7%) patients were diagnosed with anastomotic stricture. Participants were randomly divided into training (n = 1079) and validation (n = 463) sets. Predictors included in this nomogram were radiotherapy, diverting stoma, anastomotic leakage, and anastomotic distance. The area under the ROC curve (AUC) for the training set was 0.889 [95% confidence interval (CI) 0.840-0.937] and for the validation set, it was 0.930 (95%CI 0.879-0.981). The calibration curve demonstrated a strong correlation between predicted and observed outcomes. DCA results showed that the nomogram had clinical value in predicting anastomotic stricture in patients after anterior resection of rectal cancer.

We developed a predictive model for anastomotic stricture following anterior resection of rectal cancer. This nomogram could assist clinicians in predicting the risk of anastomotic stricture, thus improving patients' quality of life and long-term prognosis.

Over the past decade, the use of stent placement as a bridge to surgery (BTS) has emerged as an alternative to emergency surgery for patients with (OCRC). However, the optimal surgical approach remains indeterminate. This study seeks to evaluate the safety and feasibility of a combined treatment modality involving stent placement and laparoscopic surgery for OCRC presenting with malignant obstruction.

A comprehensive search of PubMed, Cochrane Library, EMBASE, Web of Science, and ClinicalTrials.gov was conducted until June 2023 to identify studies that compared laparoscopic to open surgery in patients with OCBC following stent insertion.

The meta-analysis incorporated 12 cohort studies, encompassing 933 patients. There was no statistically significant difference in the 30-day mortality rates between the two groups (relative risk [RR], 1.09; 95% confidence interval [CI] 0.26 to 4.48; P = 0.95). Compared to the laparoscopic approach group, the open approach group had a higher rate of overall postoperative complications (POCs) (RR 0.52; 95% CI 0.37 to 0.72, P < 0.0001). There was no significant variance in lymph node (LN) dissection number between the groups (mean differences [MD], 1.64; 95% CI - 1.51 to 4.78; P = 0.31). Notably, laparoscopic surgery resulted in less intraoperative blood loss (MD, - 25.84 ml; 95% CI - 52.16 to 0.49; P = 0.05) and a longer operation time (MD, 20.99 mins; 95% CI 2.31 to 39.44; P = 0.03). The laparoscopic approach was associated with a shorter length of hospital stay (LOS) (MD - 3.29 days; 95% CI - 5.27 to 1.31; P = 0.001). Conversely, the open approach group had a higher rate of postoperative surgical site infection (SSI) (RR 0.47; 95% CI 0.23 to 0.96, P = 0.04). Although the number of included studies was insufficient to conduct a meta-analysis, several of them imply that laparoscopic surgery may yield more favorable outcomes in terms of the 3-year overall survival rate (OS), 3-year disease-free survival rate (DFS), 5-year OS, and 5-year DFS when compared to open surgery. It is worth noting that these differences lack statistical significance.

In patients with OCRC subjected to stent insertion, laparoscopic surgery arguably presents a modest superiority over open surgery by diminishing the overall postoperative risk and potentially reducing the LOS.

Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer mortality globally. Large bowel obstruction (occurring in 15-30% of patients with CRCs) accounts for approximately 80% of medical emergencies related to CRC. Currently, there is no standard treatment of this condition. The European Society of Gastrointestinal Endoscopy (ESGE) recommends self-expandable metal stent (SEMS) as a bridge (two weeks) to surgery for left-sided obstructing colon cancer. In the present report, we describe an 81-year-old male with colon cancer who underwent colon stent placement for 32 months, but later underwent radical resection. A follow-up of more than four-months revealed that his condition was normal. The history as well as application and advantages of SEMS are discussed in this report.