Analysis of Perioperative Complications and Long-term Prognosis in the Treatment of Complete Obstructive Left-sided Colon Cancer with Self-expanding Metallic Stent Placement Combined with Neoadjuvant Chemotherapy

Objective: To investigate the perioperative complications and long-term outcomes of self-expanding metallic stent (SEMS) placement combined with neoadjuvant chemotherapy followed by elective surgery in patients with complete obstructive left-sided colon cancer. Methods: A retrospective analysis was conducted on the clinical data of 82 patients with complete obstructive left-sided colon cancer from January 2014 to May 2023, which was registered at ClinicalTrials.gov (Identifier: NCT02972541) Beijing Chao Yang Hospital. Based on the treatment strategy, patients were divided into the SEMS-surgery group (35 cases) and the SEMS-neoadjuvant-surgery group (47 cases). The primary outcome measures were overall survival (OS), disease-free survival (DFS), and the incidence of SEMS-related complications (perforation, re-obstruction, migration, and unresolved obstruction) after SEMS placement. Results: All patients were followed up, with a median follow-up period of 55 (12–112) months. The incidence of SEMS-related complications did not differ significantly between the two groups (14.9% vs. 17.1%, P=0.783). Specifically, there were no significant differences in the rates of perforation (6.4% vs. 8.6%, P=1.000), re-obstruction (5.7% vs. 6.4%, P=1.000), migration (2.0% vs. 0.0%, P=1.000), or unresolved obstruction (0.0% vs. 2.3%, P=0.427). The SEMS-neoadjuvant-surgery group demonstrated significantly higher 5-year OS (78.3% vs. 51.7%, P=0.048) and 5-year DFS (73.9% vs. 41.4%, P=0.019) compared to the SEMS-surgery group. The 5-year local recurrence rate (2.1% vs. 14.3%, P=0.037) and distant metastasis rate (12.8% vs. 34.3%, P=0.020) were significantly lower in the SEMS-neoadjuvant-surgery group. Conclusion: The SEMS-neoadjuvant-surgery strategy significantly improves surgical outcomes, enhances long-term survival rates, and reduces the risk of postoperative local recurrence and distant metastasis in patients with obstructive left-sided colon cancer without increasing the risk of SEMS-related complications.