Comparative effectiveness of neoadjuvant therapy combined with stent placement versus stent alone in obstructive colorectal cancer: a multicenter retrospective analysis.

چکیده اصلی

OBJECTIVE: The aim of this study was to evaluate the impact of self-expandable metal stents (SEMS) and neoadjuvant therapy (NAT) for obstructive colorectal cancer (CRC). METHODS: This multicenter, retrospective study analyzed 154 patients with obstructive CRC from three centers between 2011 and 2025. Patients were allocated to either a NAT combined with SEMS group (n = 93) or a SEMS-alone group (n = 61). Short-term procedural outcomes, pathological tumor response, long-term survival, and the impact of the time interval from stenting to surgery were evaluated between groups and across two time periods (2011-2020 vs. 2021-2025). RESULTS: Baseline characteristics were largely comparable between groups. The NAT group demonstrated significantly lower intraoperative stoma rates (8.6% vs. 29.0%, P = 0.031) and postoperative complication rates (8.6% vs. 29.0%, P = 0.031) in the 2011-2020, advantages that persisted in the 2021-2025. Pathological assessment revealed a superior tumor response in the 2021-2025, with 20.7% achieving TRG 0-1 and significantly higher rates of T and N downstaging (39.7% and 60.3%) compared to the 2011-2020. Although survival benefits were not significant in the 2011-2020 period, NAT may be associated with a significant improvement in overall survival (OS) in the 2021-2025 cohort (P = 0.013). Analysis of surgical timing identified an optimal interval of 14-21 days related to OS for the SEMS group, whereas for NAT patients, an interval exceeding 90 days was associated with worse disease-free survival (DFS). CONCLUSION: SEMS-NAT for obstructive CRC may is an important factor for improved surgical quality and OS benefit in 2021-2025. This study provides crucial evidence for optimizing treatment strategy by recommending a surgery interval.

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