Short- and long-term outcomes after colonic stent insertion as a bridge to surgery in elderly colorectal cancer patients

Abstract

Abstract Purpose: Colonic stents have been inserted as a bridge to surgery in patients with resectable colorectal cancer, allowing bowel decompression for systemic assessment and better preparation to avoid stoma construction. However, reports of short- and long-term prognoses for elderly patients remain limited. Methods: This retrospective study reviewed 175 consecutive patients who underwent colonic stent insertion for bowel obstruction followed by colorectal resection between 2016 and 2021. All cases were diagnosed with stage II/III pathologically. Patients were divided into those ³80 years old (Old, n=49) and those <80 years old (Young, n=126). Propensity score matching was applied to minimize selection biases, with 41 patients in each group matched and analyzed. Results: Before matching, performance status was poorer (performance status 3: 26.5% vs 4.8%; p<0.001), postoperative complication rate was higher (36.7% vs 17.5%; p=0.009), adjuvant chemotherapy rate was lower (8.2% vs 53.2%; p<0.001), and hospital stay was longer (16 vs 13 days; p<0.001) in the Old group. After matching, adjuvant chemotherapy rate was lower (9.8% vs 39.0%; p=0.003) and hospital stay was longer (14 vs 12 days; p=0.029) in the Old group. However, postoperative complication rates were comparable between groups (31.7% vs 26.8%; p=0.808), as were 5-year relapse-free survival rate (42.9% vs 68.8%; p=0.200), overall survival rate (66.3% vs 87.7%; p=0.081), and cancer-specific survival rate (68.2% vs 87.7%; p=0.129). Conclusions: Colorectal resection after colonic stent insertion is useful for elderly patients, with potential to reduce postoperative complication rates and achieve good long-term results with appropriate case selection.