LAUSR

BACKGROUND Colonic stenting reduces morbidity and stoma formation for left-sided colon cancer obstruction, and prolonged interval between stenting and surgery with neoadjuvant chemotherapy administered might result in a lower stoma rate and tumor reduction. OBJECTIVE To evaluate the short-term outcomes of elective surgery following colonic stenting compared with elective surgery following colonic stenting and neoadjuvant chemotherapy in patients with left-sided colon cancer obstruction. DESIGN A prospective multicenter cohort study. SETTINGS This study was conducted in 5 medical centers. PATIENTS Patients (n = 100) with acute left-sided colon cancer obstruction undergoing colonic stenting between December 2015 and December 2019 were included. INTERVENTIONS Patients were assigned to the stenting alone or chemotherapy group. MAIN OUTCOME MEASURES The primary outcomes measured were laparoscopic surgery and stoma rate. RESULTS Of the 100 patients who underwent colonic stenting, 52 were assigned to the stenting group and 48 were assigned to the chemotherapy group. No statistically significant differences were detected in stent-related complications. The adverse events associated with neoadjuvant chemotherapy were well-tolerated. Hemoglobin (117.2 g/L vs. 107.6 g/L; p = 0.008), albumin (34.2 g/L vs. 31.5 g/L; p < 0.001), and prealbumin (0.19 g/L vs. 0.16 g/L; p = 0.001) were significantly increased, and the bowel wall thickness (1.09 mm vs. 2.04 mm; p < 0.001) was significantly decreased preoperatively in the chemotherapy group compared to the stenting group. The number of mean harvested lymph nodes was greater in the chemotherapy group than the stenting group (25.6 vs. 21.8; p = 0.04). Laparoscopic surgery was performed more frequently (77.1% vs. 40.4%; p < 0.001) and a stoma was created less frequently (10.4% vs. 28.8%; p = 0.02) in the chemotherapy group than the stenting group. LIMITATIONS This trial was limited by the non-randomized design and short follow-up period. CONCLUSIONS This study suggests that elective surgery following neoadjuvant chemotherapy and colonic stenting is a safe, effective, and well-tolerated treatment approach with a high laparoscopic resection rate and a low stoma rate. See Video Abstract at http://links.lww.com/DCR/B980.