Comparative Study on the Efficacy and Safety of Emergency Surgery Versus Endoscopic Stent Placement Followed by Definitive Surgery in the Treatment of Colorectal Obstruction

Abstract

AIM: Tumor-induced acute intestinal obstruction is a severe complication that poses significant threats to patient life. Emergency surgery is a widely used treatment method, but this approach has certain limitations such as high mortality and complication rates. Developments in endoscopic and minimally invasive techniques have provoked interest in postoperative definitive resection or conservative treatment following colorectal stent placement. Hence, this study aims to explore the clinical efficacy and safety of endoscopic-guided, X-ray-assisted intestinal stent placement in colorectal cancer (CRC) with acute intestinal obstruction, and to provide clinicians with viable alternative treatment options to enhance patient care.

METHODS: This study included 69 CRC patients who received treatment at the Affiliated Jinhua Hospital, Zhejiang University School of Medicine, China, between August 2017 and August 2021. The control group (n = 38) underwent emergency laparotomy with one-stage resection and stoma formation, followed by a postoperative second-stage stoma closure every 3 to 6 months. Moreover, the experimental group (n = 31) underwent endoscopic stent placement followed by definitive surgery. The differences in various indicators were compared between groups. Additionally, the 1-year and 3-year overall survival (OS) rates and disease-free survival (DFS) rates were compared between groups.

RESULTS: Successful placement of intestinal stents was achieved in all 31 patients, with acute intestinal obstruction relief within 24 to 48 hours. In the experimental group, stent placement effectively relieved intestinal obstruction, and a postoperative radical colon surgery was performed after 7 to 10 days. The experimental group had significantly lower rates of postoperative ventilator time, reduced time to oral intake, and fewer complication than the control group (p < 0.05). However, no significant differences were observed between groups regarding operation time, intraoperative blood loss, 1-year and 3-year OS rates, and 1-year and 3-year DFS rates (p > 0.05).

CONCLUSIONS: Compared to emergency surgery, combined endoscopic and X-ray-guided colonic stent placement is an effective and safer method for alleviating acute intestinal obstruction in colorectal cancer. This study provides valuable insights to clinicians in selecting treatment options.