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

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 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article 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 yang shi, zhi wei zhai, ke cao, chun xiang ye, yan sen li, guang hui wei, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6830907/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract 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. self-expanding metallic stents neoadjuvant chemotherapy completely obstructive left-sided colon cancer complications long-term efficacy Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Colorectal cancer represents approximately 10% of all cancer diagnoses globally each year 1 . Of these, about 4%-22% of patients present with acute intestinal obstruction as their initial symptom 2 . While emergency surgery remains the primary treatment for acute complete obstructive left-sided colon cancer, clinical practice has shown that self-expanding metallic stents (SEMS) can be significantly effective. SEMS can relieve acute obstruction and convert emergency surgery into a staged operation, providing patients with a critical time window to correct fluid imbalances, receive nutritional support, and restore cardiopulmonary function 3 4 . Numerous studies have reported that SEMS have a high clinical and technical success rate, which can improve primary anastomosis rates, reduce postoperative complications, and exhibit favorable short-term outcomes. As a result, SEMS has been widely used in treating complete obstructive colon cancer 5-8 , although its long-term efficacy remains controversial 9 10 . Some studies suggest that SEMS placement can lead to tumor compression and mechanical pressure on the intestine, potentially causing tumor cell dissemination, colon perforation, and other complications 11 12 . Therefore, our center proposes performing neoadjuvant chemotherapy after SEMS placement to appropriately extend the preoperative waiting time. This method enhances the patient's overall health and local bowel environment while also aiding in the control of local tumors and potential metastatic lesions, thereby increasing the effectiveness and radicality of the surgery 7 13 . Preliminary retrospective studies have shown that the SEMS-neoadjuvant-surgery strategy can improve the surgical outcomes of completely obstructive left-sided colon cancer, with no local recurrence or distant metastasis observed during a 3-year follow-up period 7 . Based on these findings, the present study aims to evaluate the impact of SEMS combined with neoadjuvant chemotherapy on perioperative complications in patients with complete obstructive left-sided colon cancer using a larger sample size. It will also explore the management of SEMS-related complications and further compare the long-term (5-year) oncological outcomes of the SEMS-surgery versus SEMS-neoadjuvant-surgery strategies, to investigate the clinical application value of SEMS placement combined with neoadjuvant chemotherapy. Methods A retrospective analysis was conducted on the clinical data of patients with complete obstructive left-sided colon cancer treated in the Department of General Surgery at Beijing Chaoyang Hospital, Capital Medical University, from January 2014 to May 2023. The inclusion criteria were as follows: 1. Diagnosis of complete left-sided colon obstruction based on clinical manifestations and imaging examinations; 2. Pathological confirmation of colonic adenocarcinoma; 3. Tumor located in the left-sided colon, from the splenic flexure to more than 15 cm from the anus; 4. Ability to tolerate SEMS placement. The exclusion criteria were as follows: 1. Patients who did not undergo surgical treatment after SEMS placement; 2. Presence of distant metastasis at the time of diagnosis; 3.Familial adenomatous polyposis; 4. Incomplete clinical data; 5. Loss to follow-up. This study was approved by the Ethics Committee of Beijing Chaoyang Hospital, Capital Medical University (Approval No: 2016-Ke-161-1). All procedures involving human participants were in accordance with the ethical standards of the 1964 Helsinki declaration and its later amendments. Written informed consent was obtained from all individual participants included in the study. This study was registered at ClinicalTrials.gov (Identifier: NCT02972541) Beijing Chao Yang Hospital. Treatment Methods (1) SEMS-surgery group : SEMS placement was performed by gastroenterologists under endoscopic guidance with a guidewire to relieve acute obstruction. Active treatment included anti-inflammatory therapy, acid suppression, and intravenous nutritional support. Nutritional support was gradually transitioned from intravenous to enteral nutrition. SEMS was left in place for about 2 weeks, and after the patient’s condition stabilized, radical surgery was performed 14 . (2) SEMS-neoadjuvant-surgery group : Gastroenterologists performed the endoscopic examination and biopsy for pathological examination, followed by SEMS placement under endoscopic guidance to relieve acute obstruction. After the obstruction was relieved, patients underwent two cycles of CAPEOX (Oxaliplatin + Capecitabine) or three cycles of mFOLFOX6 (Oxaliplatin + Leucovorin + 5-Fluorouracil) chemotherapy. After completing neoadjuvant chemotherapy, surgery was performed 2–3 weeks later. All patients were given adjuvant chemotherapy based on postoperative pathological results and personal preferences. Observation Indicators (1) Primary Outcome Indicators : 5-year overall survival (OS), disease-free survival (DFS), and SEMS-related complication rates (perforation, re-obstruction, migration, and unresolved obstruction). OS is defined as the time from radical surgery until death or the end of follow-up; DFS is defined as the time from radical surgery until tumor metastasis, recurrence, death, or the end of follow-up. Re-obstruction is defined as a narrowing or complete obstruction of the SEMS placement site after SEMS relief, leading to a failure of the expected passage of intestinal contents. (2) Secondary Outcome Indicators : 5-year distant metastasis rate, 5-year local recurrence rate, laparoscopic surgery proportion, surgery duration, intraoperative blood loss, number of lymph nodes retrieved, number of positive lymph nodes retrieved, postoperative hospital stay, ileostomy rate, postoperative early complication rate, and complication severity. Postoperative early complications are any clinical conditions occurring within 30 days after surgery that require prolonged hospitalization or deviate from the normal postoperative course. Postoperative complications were graded according to the Clavien-Dindo classification system 15 : Follow-up and data collection Postoperative follow-up was conducted through outpatient visits and telephone follow-ups. Telephone follow-ups were conducted before outpatient visits to inquire about the patient's health status and remind them of the upcoming appointment. Outpatient visits were every 3 months for the first 2 years, then every 6 months for 5 years. The endpoint event for follow-up was defined as the occurrence of tumor metastasis, recurrence, or death. The follow-up period was until May 2024. Statistical analysis Comparisons of baseline characteristics and the postoperative outcomes were performed by the Mann–Whitney U test and independent t-tests for continuous variables and the x² test for categorical variables. Fisher’s exact test compared all categorical variables. Disease-free and overall survival were estimated using the Kaplan–Meier method, comparing treatment groups using the Log-rank test. Cox regression analysis was used to identify independent risk factors affecting patient survival prognosis. A two-sided p-value of less than 0.05 was considered statistically significant. Statistical analysis was performed using SPSS 27.0.1 (IBM, USA). Results Baseline Data A total of 106 patients with complete obstructive left-sided colon cancer were initially included. After excluding 24 patients (14 lost to follow-up, 8 with distant metastasis at initial diagnosis, and 2 with incomplete clinical data), 82 were ultimately enrolled in the study. The treatment strategies included the SEMS-surgery approach in 35 cases and the SEMS-neoadjuvant-surgery approach in 47 cases. All patients were followed up, with a median follow-up time of 55 (12–112) months. The median follow-up time for the SEMS-surgery group was 73 (17–112) months, while the median follow-up time for the SEMS-neoadjuvant-surgery group was 46 (12–106) months. The median age of patients in both groups was 67.8 years, with the most common tumor location being the sigmoid colon. Except for the preoperative waiting time, other indicators had no statistically significant differences (P > 0.05). The preoperative waiting time for the SEMS-neoadjuvant-surgery group was significantly longer than that of the SEMS-surgery group(75.2 ± 38.4 days vs. 29.3 ± 27.5 days, P = 0.001), which is shown in Table 1. Comparison of intraoperative indicators and postoperative pathological findings Compared to the SEMS-surgery group, the SEMS-neoadjuvant-surgery group had a higher proportion of laparoscopic surgeries (89.4% vs. 65.7%, P = 0.007), shorter postoperative hospital stays (10.0 ± 3.3 days vs. 13.5 ± 5.3 days, P = 0.001), and lower ileostomy rates (10.6% vs. 28.6%, P = 0.038). There were no statistically significant differences between the two groups regarding surgery duration and blood loss (P > 0.05). Postoperative pathological results showed that the number of lymph nodes retrieved in the SEMS-neoadjuvant-surgery group was significantly higher (30.3 ± 16.0 vs. 23.0 ± 10.0, P=0.021). Still, there was no significant difference in the number of positive lymph nodes (P > 0.05). Results are shown in Table 1. Postoperative Complications A total of twenty patients (24.4%) developed early postoperative complications within 30 days. The SEMS-neoadjuvant-surgery group (seven cases) had a significantly lower early complication rate compared to the SEMS-surgery group (thirteen cases) (14.9% vs. 37.1%, P = 0.020). A total of thirty early postoperative complications occurred in twenty patients, with the SEMS-neoadjuvant-surgery group having ten and the SEMS-surgery group having twenty. Among the SEMS-neoadjuvant-surgery group, two patients had more than two complications, while seven patients in the SEMS-surgery group had more than two complications. The most common early postoperative complications in the SEMS-surgery group were lung infections (25.7%) and wound infections (20.0%). The SEMS-neoadjuvant-surgery group had significantly lower rates of wound infection (4.3% vs. 20.0%, P = 0.029) and lung infection (6.4% vs. 25.7%, P = 0.014) compared to the SEMS-surgery group. No significant differences were found in other postoperative complication rates (P > 0.05). There were no significant differences in the severity of postoperative complications between the two groups (P > 0.05). Results are shown in Table 2. SEMS and Chemotherapy-Related Complications Thirteen patients (15.9%) developed SEMS-related complications after SEMS placement but before surgery. Among them, six cases (7.3%) experienced perforation, with 3 cases in the SEMS-surgery group(6.4%) and 3 cases in the SEMS-neoadjuvant-surgery group(8.6%). Re-obstruction occurred in five cases (6.1%), with 3 cases in the SEMS-surgery group(6.4%) and 2 cases in the SEMS-neoadjuvant-surgery group(5.7%). One SEMS migration (1.2%) in the SEMS-neoadjuvant-surgery group and one unresolved obstruction (1.2%) occurred in the SEMS-surgery group (2.9%) after SEMS placement. No bone marrow suppression was observed in the patients undergoing neoadjuvant chemotherapy. Compared to the SEMS-surgery group, the SEMS-neoadjuvant-surgery group had no significant differences in the overall rate of SEMS-related complications (14.9% vs. 17.1%, P = 0.783), perforation rate (6.4% vs. 8.6%, P = 1.000), re-obstruction rate (6.4% vs. 5.7%, P = 1.000), migration rate (2.0% vs. 0.0%, P = 1.000), or unresolved obstruction rate (0.0% vs. 2.3%, P = 0.427). Results are shown in Table 2. Long-Term Efficacy Comparison The 5-year OS (78.3% vs. 51.7%, P = 0.048) and 5-year DFS (73.9% vs. 41.4%, P = 0.019) were all significantly higher in the SEMS-neoadjuvant-surgery group compared to the SEMS-surgery group, with statistical significance. Results are shown in Table 3. Kaplan-Meier survival analysis showed that the median survival time for the SEMS-surgery group was 70.5 (95% CI 52.6–88.4) months, while the median survival time for the SEMS-neoadjuvant-surgery group was 90.3 (95% CI 76.1–104.6) months. The median disease-free survival time for the SEMS-surgery group was 65.3 (95% CI 47.3–83.2) months, while the median disease-free survival time for the SEMS-neoadjuvant-surgery group was 94.2 (95% CI 81.0–107.3) months. Log-rank test results showed significant differences between the two groups' median survival and disease-free survival times (P = 0.029, 0.007). Results are shown in Figures 1 and 2. Cox regression analysis showed that for patients with obstructive left colon cancer, immediate surgery after SEMS placement (SEMS-surgery approach) was an independent risk factor for OS (HR=0.401, 95% CI: 0.174–0.926, P=0.032) and DFS (HR=0.394, 95% CI: 0.184–0.843, P=0.016), In cox regression analysis, SEMS-related complications emerged as an independent risk factor for OS (HR=0.325, 95% CI: 0.121-0.868; P=0.025) but showed no significant association with DFS (P=0.066). Results are shown in Figures 3 and 4. After excluding patients with follow-up times < 5 years, the 5-year OS (87.5% vs. 57.1%, P = 0.045) and 5-year DFS (81.3% vs. 47.6%, P = 0.037) in the SEMS-neoadjuvant-surgery group remained higher than those in the SEMS-surgery group, with statistically significant differences. Among all cases, six patients (7.3%) developed local tumor recurrence within 5 years postoperatively, and eighteen patients (22.0%) developed distant metastasis within 5 years postoperatively. The 5-year local recurrence rate and distant metastasis rate in the SEMS-neoadjuvant-surgery group were lower than those in the SEMS-surgery group, with statistically significant differences (P < 0.05). Results are shown in Table 3. The 47 patients who received the SEMS-neoadjuvant treatment plan were divided into two subgroups based on whether they received CAPEOX (31 patients) or mFOLFOX6 (16 patients). There were no statistically significant differences between the two subgroups in the 5-year local recurrence rate (3.2% vs. 0.0%, P = 0.468), 5-year metastasis rate (9.7% vs. 18.8%, P = 0.377), 5-year OS (78.6% vs. 77.8%, P = 0.964), or 5-year DFS (71.4% vs. 77.8%, P = 0.735). Table 1: Baseline data and surgical outcomes Variables SEMS-surgery group （n=35） SEMS-neoadjuvant-surgery group（n=47） statistical value P-Value Gender 0.125 0.724 Male，（%） 21（60.0%） 30（63.8%） Female，（%） 14（40.0%） 17（36.2%） Age，（year) 68.8±11.7 66.8±10.2 1.004 0.319 BMI，(kg/m 2 ) 22.4±3.7 22.3±3.1 0.168 0.867 Comorbidities，（%） Hypertension 19（54.3%） 16（34.0%） 2.584 0.108 Diabetes 2（5.7%） 7（14.9%） 1.730 0.188 Coronary Artery Disease 2（5.7%） 4（8.5%） 0.231 0.631 ASA Score，（%） 2.214 0.330 2 20（57.1%） 32（68.1%） 3 12（34.3%） 14（29.8%） 4 3（8.6%） 1（2.1%） Tumor Location，（%） 1.080 0.897 Transverse Colon 3（8.6%） 2（4.3%） Splenic Flexure of Colon 2（5.7%） 3（6.4%） Descending Colon 7（20.0%） 11（23.4%） Sigmoid Colon 23（65.7%） 31（66.0%） T Stage，（%） 0.981 0.322 T3 17（48.6%） 28（59.6%） T4 18（51.4%） 19（40.4%） N Stage，（%） 0.308 0.857 N0 18（51.4%） 24（51.1%） N1 12（34.3%） 18（38.3%） N2 5（14.3%） 5（10.6%） TNM Stage，（%） 0.001 0.974 Stage II 18（51.4%） 24（51.1%） Stage III 17（48.6%） 23（48.9%） Differentiation Grade，（%） 2.492 0.288 Well-differentiated 0（0.0%） 1（2.1%） Moderately differentiated 32（91.4%） 45（95.7%） Poorly differentiated 3（8.6%） 1（2.1%） Hemoglobin，（g/l） 107.6±16.2 103.0±16.6 1.221 0.226 Platelets，（10 9 /L） 232.0±70.1 205.8±68.0 1.659 0.101 Creatinine，（umol/l） 61.5±15.9 54.8±18.5 1.822 0.072 Albumin，（g/l） 30.9±7.1 32.4±7.9 -0.941 0.349 ALT，（U/L） 18.5±14.2 16.3±9.8 0.841 0.403 AST，（U/L） 21.6±10.7 22.4±10.7 -0.337 0.737 Lymphocytes，（10 9 /l） 1.0±0.7 1.1±0.9 -0.563 0.575 Neutrophils，（10 9 /L） 8.3±3.3 7.4±2.9 1.429 0.157 Preoperative Waiting Time ，（Weeks） 3.3±3.6 10.6±5.7 44.923 0.001 Postoperative Adjuvant Chemotherapy，（%） 20（57.1%） 33（70.2%） 1.499 0.221 Surgical Approach，（%） 7.179 0.007 Laparoscopy 23（65.7%） 42（89.4%） Open Surgery 12（34.3%） 5（10.6%） Surgical Time，（min） 205（180~254） 200（170~225） 0.506 0.614 Blood Loss，（ml） 149.4±138.5 135.3±114.2 0.491 0.625 Lymph Node Retrieval,（Count） 23.0±10.0 30.3±16.0 -2.359 0.021 Positive Lymph Node Retrieval （Count） 0.5（0.0~3.0） 0.0（0.0~2.0） 0.427 0.513 Postoperative Hospital Stay，（Days） 13.5±5.3 10.0±3.3 8.096 0.001 Ileostomy Rate，（%） 10（28.6%） 5（10.6%） 4.316 0.037 Table 2: Comparison of complication rates of patients after SEMS placement Complications SEMS-surgery group （n=35） SEMS-neoadjuvant-surgery group（n=47） statistical value P-Value SEMS-related complications rate，（%） 6（17.1%） 7（14.9%） 0.076 0.783 Perforation，（%） 3（8.6%） 3（6.4%） 0.142 1.000 Re-obstruction，（%） 2（5.7%） 3（6.4%） 0.016 1.000 Displacement，（%） 0（0.0%） 1（2.0%） 0.754 1.000 Unresolved obstruction，（%） 1（2.3%） 0（0.0%） 1.359 0.427 Postoperative early complications rate，（%） 13（37.1%） 7（14.9%） 5.385 0.020 Incision infection，（%） 7（20.0%） 2（4.3%） 5.090 0.029 Pulmonary infection, （%） 9（25.7%） 3（6.4%） 6.001 0.014 Postoperative bowel obstruction，（%） 2（5.7%） 1（2.1%） 0.732 0.392 Lower extremity venous thrombosis，（%） 2（5.7%） 0（0.0%） 2.753 0.097 Gastric paralysis，（%） 0（0.0%） 1（2.1%） 0.754 1.000 Urinary tract infection，（%） 0（0.0%） 1（2.1%） 0.754 1.000 Septicemia,（%） 0（0.0%） 1（2.1%） 0.754 1.000 Anastomotic leakage，（%） 0（0.0%） 1（2.1%） 0.754 1.000 Postoperative complications grade，（%） 13（100%） 7（100%) 3.263 0.353 Grade 1 10（76.9%） 3（42.9%） Grade 2 2（15.4%） 2（28.6%） Grade 3 0（0.0%） 1（14.3%） Grade 4 1（7.7%） 1（14.3%） The SEMS-surgery group had thirteen patients with twenty postoperative early complications, while the SEMS-neoadjuvant-surgery group had seven patients with ten postoperative early complications. Table 3: Long-term survival outcomes of patients after SEMS placement. Outcome SEMS-surgery group （n=35） SEMS-neoadjuvant-surgery group（n=47） statistical value P-Value 5-year Overall Survival Rate，（%） 15（51.7%） 18（78.3%） 3.895 0.048 5-year Disease-Free Survival Rate,（%） 12（41.4%） 17（73.9%） 5.504 0.019 5-year Local Recurrence Rate，（%） 5（14.3%） 1（2.1%） 4.373 0.037 5-year Distant Metastasis Rate 12（34.3%） 6（12.8%） 5.423 0.020 Discussion The use of SEMS for the treatment of completely obstructive left-sided colon cancer was first reported in 1994 16 . The placement of SEMS provides patients with acute intestinal obstruction an opportunity to convert emergency surgery into elective surgery 17 . SEMS has gradually become an alternative treatment for emergency surgery 18 , which has been widely applied in treating obstructive colon cancer 19 – 21 . Our study showed that compared to the SEMS-surgery group, the SEMS-neoadjuvant-surgery group significantly increased the proportion of laparoscopic surgeries, the number of lymph nodes detected, as well as 5-year OS, and DFS, shortened postoperative hospital stay, and reduced the rates of ileostomy, early postoperative complications, and 5-year local recurrence and distant metastasis. This confirms the short-term surgical and long-term oncological effectiveness of elective surgery for completely obstructive left-sided colon cancer after SEMS placement combined with neoadjuvant chemotherapy. The rate of stoma formation and postoperative complications is closely linked to the patient's quality of life after surgery 22 23 . Studies indicate that using SEMS as a bridge to surgery can shorten hospital stays, reduce ileostomy rates, and lower postoperative complications compared to emergency surgery 24 25 . SEMS allows for improved patient conditions and reduced bowel wall edema, enhancing the safety of primary anastomosis 26 . However, some studies suggest that even with surgery two weeks after SEMS placement, bowel wall edema can persist, and ileostomy rates remain high at 29.1% 27 28 . In our research, the SEMS-neoadjuvant-surgery group, with a preoperative waiting time of 10 weeks, had a much lower ileostomy rate of 10.6%, shorter hospital stays, and fewer complications. This suggests extending the waiting time after SEMS placement can improve patient outcomes. We believe this finding is also associated with the significantly increased lymph node yield observed in the SEMS-neoadjuvant-surgery group. Previous studies have identified several key factors contributing to low lymph node retrieval, including intraoperative bowel wall edema, poor surgical field visualization, and a high proportion of palliative surgeries 24 25 . The SEMS-neoadjuvant-surgery strategy extends the preoperative waiting period, improves patient conditions, and consequently leads to a marked increase in lymph node harvest. Perforation is the most common and serious complication occurring within the first two weeks after SEMS placement, often leading to acute peritonitis and requiring emergency surgery 29 30 . This complication is typically caused by reduced luminal compliance and the expansion force of the SEMS 31 – 33 . The decrease in luminal compliance is influenced by factors such as increased collagen fibers around the tumor and reduced smooth muscle cells due to tumor invasion, alongside severe stenosis from tumor growth, further narrowing the intestinal diameter 34 . Consequently, significant collagen proliferation and severe stenosis can help predict perforations 35 . In our study, most perforations also occurred within two weeks post-SEMS placement, suggesting that a preoperative waiting period for neoadjuvant chemotherapy may not considerably raise the risk of perforation. Notably, 83.3% of perforations occurred at the proximal flared end of the SEMS, likely due to the expansion force and sharp edges, combined with intestinal peristalsis and the pressure from intestinal contents, creating tremendous stress on the intestinal wall. Research shows that the risk of colon perforation is nearly three times higher in patients treated with bevacizumab after SEMS placement 36 . Bevacizumab may lead to perforation by promoting tumor regression that penetrates the colon's serosal layer or by causing local ischemia and hindering ulcer healing 37 . Our study noted one case of perforation after bevacizumab use. While some studies suggest that bevacizumab doesn't significantly increase the risk of perforation and may prolong survival when combined with chemotherapy 38 , it is still advisable to avoid its use during neoadjuvant chemotherapy after SEMS placement when possible. Tumor overgrowth into the intestinal lumen is the leading cause of re-obstruction, along with fecal impaction and mucosal prolapse 39 . Research shows that SEMS primarily enlarges the bowel lumen but does not prevent tumor growth, especially with uncovered stents, which allow tumor cells to invade the mesh 40 . As a result, re-obstructions often happen weeks after SEMS placement, aligning with the findings of our study. Some studies suggest that re-obstruction may be linked to fecal impaction. This occurs when consuming high-fiber, residue-rich, and difficult-to-digest foods leads to stool accumulation within the stent lumen, resulting in obstruction 41 . Therefore, advising patients to eat easily digestible, low-residue foods, along with using laxatives, may help decrease the occurrence of re-obstruction after the placement of SEMS 42 . Studies indicate that covered stents have a migration rate of 11.8% 39 , primarily because they are harder to anchor securely, making them vulnerable to displacement from tumor pressure and intestinal movement 43 . At our center, we use uncovered stents, which reduce the risk of migration despite a slightly higher chance of re-obstruction 44 . Further research is needed to explore the relationship between covered and uncovered stents regarding these risks. A meta-analysis found that SEMS-surgery has a higher overall recurrence rate than emergency surgery (37.0% vs. 25.9%, P = 0.049) 45 . This difference may arise from mechanical compression of tumors by SEMS, which can lead to the spread of tumor cells into the bloodstream 46 . Studies have shown an increase in circulating tumor cells and cytokeratin-20 mRNA expression in patients after SEMS placement, suggesting it may facilitate tumor dissemination 11 12 . Additionally, SEMS placement is associated with higher rates of perineural and vascular invasion, which are risk factors for metastasis and recurrence 46 . However, neoadjuvant chemotherapy has been shown to reduce these invasions 47 – 50 . Our research indicates that combining SEMS with neoadjuvant chemotherapy significantly decreases 5-year rates of distant metastasis and local recurrence, potentially improving patient outcomes by eliminating tumor cells and controlling tumor spread. Some meta-analyses have shown no significant difference in long-term survival between the SEMS-bridging and emergency surgery groups 6 8 9 . However, other studies have reported varying results. Some researchers found that the 5-year OS rate was lower in the SEMS group compared to the emergency surgery group (30% vs. 67%, P = 0.001) 51 . Neoadjuvant chemotherapy has been demonstrated to significantly improve prognosis in colorectal cancer patients by inducing tumor regression while maintaining a high safety profile 52 . Our center proposed a strategy combining SEMS placement with neoadjuvant chemotherapy and found it effective in the short term 7 . A retrospective analysis of clinical data from patients who underwent emergency surgery and SEMS-neoadjuvant-surgery indicated that the 1-year DFS rate in the SEMS-neoadjuvant-surgery group was slightly higher than in the emergency surgery group. However, this difference was insignificant (96.8% vs. 91.3%, P = 0.562) 27 . This may be attributed to the small sample size and short follow-up duration. Our study's long-term follow-up results indicated that patients in the SEMS-neoadjuvant-surgery group experienced significantly better OS and DFS in 5 years compared to those in the SEMS-only group. Furthermore, the SEMS-surgery strategy emerged as an independent risk factor influencing the survival prognosis of patients with obstructive left-sided colon cancer. These findings suggest that the SEMS-neoadjuvant-surgery strategy may enhance the long-term prognosis for patients with this condition. This study has some limitations. Firstly, it is a single-center, retrospective case-control study, which means the sample size was relatively small. Additionally, the study did not include a group for emergency surgeries, limiting our ability to make a three-way comparison. We anticipate future large-sample, prospective, multicenter clinical studies that will provide a more accurate assessment of the incidence of complications related to SEMS-neoadjuvant-surgery and long-term survival outcomes. Conclusion This study shows that the strategy of SEMS-neoadjuvant-surgery significantly enhances surgical outcomes and long-term prognosis for patients with obstructive left-sided colon cancer, compared to the SEMS-surgery strategy. Significantly, this combined approach does not increase the risk of complications related to the SEMS. These findings suggest promising clinical applications and preliminarily confirm this approach's safety, effectiveness, and long-term benefits. However, it is essential to continue monitoring and managing patients who undergo SEMS placement in clinical practice. Abbreviations self-expanding metallic stent SEMS overall survival OS disease-free survival DFS Declarations Funding : Multidisciplinary Clinical Research Innovation Team Project of Beijing Chaoyang Hospital (CYDXK202206); National Natural Science Foundation of China (82070685). Ethics Declarations: This study was approved by the Ethics Committee of Beijing Chaoyang Hospital, Capital Medical University (Approval No: 2016-Ke-161-1). All procedures involving human participants were in accordance with the ethical standards of the 1964 Helsinki declaration and its later amendments. Written informed consent was obtained from all individual participants included in the study. Conflict of interest: The authors of the article do not have commercial associations (e.g., consultancies, stock ownership, equity interests, patent-licensing arrangements) that might pose a conflict of interest in connection with the submitted article. There are no conflicts of interest associated with any of the senior authors or other coauthors who contributed their efforts to the preparation of this manuscript. Authors’ contributions: Y.S and Z.W.Z wrote the main manuscript; J.G.H and K.C revise the manuscript; C.X.Y, Y.S.L, G.H.W and H.Q collect data; J.G.H and Z.J.W design the work. All authors reviewed the manuscript. Data availability: All data generated or analyzed during this study are included in this published article. References Dekker E, Tanis PJ, Vleugels JLA, Kasi PM, Wallace MB. Colorectal cancer. Lancet . 2019;394(10207):1467-1480. doi:10.1016/S0140-6736(19)32319-0 Fabregas JC, Ramnaraign B, George TJ. Clinical Updates for Colon Cancer Care in 2022. Clin Colorectal Cancer. 2022;21(3):198-203. doi:10.1016/j.clcc.2022.05.006 Veld JV, Amelung FJ, Borstlap WAA, et al. Changes in Management of Left-Sided Obstructive Colon Cancer: National Practice and Guideline Implementation. J Natl Compr Canc Netw . 2019;17(12):1512-1520. doi:10.6004/jnccn.2019.7326 Yuichiro Y, Shigenobu E, Hiroaki N, et al. Laparoscopic resection after self-expanding stent insertion for obstructive left-sided colorectal cancer: Clinicopathological features and outcomes. Scand J Surg 2022;111(2) doi: 10.1177/14574969221096191 Yokoyama Y, Emoto S, Nozawa H, et al. Laparoscopic resection after self-expanding stent insertion for obstructive left-sided colorectal cancer: Clinicopathological features and outcomes. Scand J Surg . 2022;111(2):14574969221096191. doi:10.1177/14574969221096191 Jain SR, Yaow CYL, Ng CH, et al. Comparison of colonic stents, stomas and resection for obstructive left colon cancer: a meta-analysis. Tech Coloproctol . 2020;24(11):1121-1136. doi:10.1007/s10151-020-02296-5 Han JG, Wang ZJ, Zeng WG, et al. Efficacy and safety of self-expanding metallic stent placement followed by neoadjuvant chemotherapy and scheduled surgery for treatment of obstructing left-sided colonic cancer. BMC Cancer . 2020;20(1):57. Published 2020 Jan 28. doi:10.1186/s12885-020-6560-x Huang X, Lv B, Zhang S, Meng L. Preoperative colonic stents versus emergency surgery for acute left-sided malignant colonic obstruction: a meta-analysis. J Gastrointest Surg . 2014;18(3):584-591. doi:10.1007/s11605-013-2344-9 Spannenburg L, Sanchez Gonzalez M, Brooks A, et al. Surgical outcomes of colonic stents as a bridge to surgery versus emergency surgery for malignant colorectal obstruction: A systematic review and meta-analysis of high quality prospective and randomised controlled trials. Eur J Surg Oncol . 2020;46(8):1404-1414. doi:10.1016/j.ejso.2020.04.052 Sato R, Oikawa M, Kakita T, et al. Comparison of the long-term outcomes of the self-expandable metallic stent and transanal decompression tube for obstructive colorectal cancer. Ann Gastroenterol Surg . 2019;3(2):209-216. Published 2019 Jan 29. doi:10.1002/ags3.12235 Gorissen KJ, Tuynman JB, Fryer E, et al. Local recurrence after stenting for obstructing left-sided colonic cancer. Br J Surg . 2013;100(13):1805-1809. doi:10.1002/bjs.9297 Maruthachalam K, Lash GE, Shenton BK, Horgan AF. Tumour cell dissemination following endoscopic stent insertion. Br J Surg . 2007;94(9):1151-1154. doi:10.1002/bjs.5790 Cao K, Wang ZJ, Han JG. [Treatment of obstructive colorectal cancer]. Zhonghua Wei Chang Wai Ke Za Zhi. 2023 Jan 25;26(1):44-50. Chinese. doi: 10.3760/cma.j.cn441530-20221114-00465. PMID: 36649999. Benson AB, Venook AP, Al-Hawary MM, Arain MA, Chen YJ, Ciombor KK, Cohen S, Cooper HS, Deming D, Farkas L, Garrido-Laguna I, Grem JL, Gunn A, Hecht JR, Hoffe S, Hubbard J, Hunt S, Johung KL, Kirilcuk N, Krishnamurthi S, Messersmith WA, Meyerhardt J, Miller ED, Mulcahy MF, Nurkin S, Overman MJ, Parikh A, Patel H, Pedersen K, Saltz L, Schneider C, Shibata D, Skibber JM, Sofocleous CT, Stoffel EM, Stotsky-Himelfarb E, Willett CG, Gregory KM, Gurski LA. Colon Cancer, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2021 Mar 2;19(3):329-359. doi: 10.6004/jnccn.2021.0012. PMID: 33724754 Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004 Aug;240(2):205-13. doi: 10.1097/01.sla.0000133083.54934.ae. PMID: 15273542; PMCID: PMC1360123. Tejero E, Mainar A, Fernández L, Tobío R, De Gregorio MA. New procedure for the treatment of colorectal neoplastic obstructions. Dis Colon Rectum. 1994 Nov;37(11):1158-9. doi: 10.1007/BF02049822. PMID: 7956588. Park SJ, Lee KY, Kwon SH, Lee SH. Stenting as a Bridge to Surgery for Obstructive Colon Cancer: Does It Have Surgical Merit or Oncologic Demerit? Ann Surg Oncol. 2016 Mar;23(3):842-8. doi: 10.1245/s10434-015-4897-1. Epub 2015 Dec 14. PMID: 26668086. Veld JV, Amelung FJ, Borstlap WAA, Eise van Halsema E, Consten ECJ, Siersema PD, Ter Borg F, Silvester van der Zaag E, Fockens P, Bemelman WA, Elise van Hooft J, Tanis PJ; Dutch Snapshot Research Group. Changes in Management of Left-Sided Obstructive Colon Cancer: National Practice and Guideline Implementation. J Natl Compr Canc Netw. 2019 Dec;17(12):1512-1520. doi: 10.6004/jnccn.2019.7326. PMID: 31805533. Vogel JD, Eskicioglu C, Weiser MR, Feingold DL, Steele SR. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Treatment of Colon Cancer. Dis Colon Rectum. 2017 Oct;60(10):999-1017. doi: 10.1097/DCR.0000000000000926. PMID: 28891842. Ansaloni L, Andersson RE, Bazzoli F, Catena F, Cennamo V, Di Saverio S, Fuccio L, Jeekel H, Leppäniemi A, Moore E, Pinna AD, Pisano M, Repici A, Sugarbaker PH, Tuech JJ. Guidelenines in the management of obstructing cancer of the left colon: consensus conference of the world society of emergency surgery (WSES) and peritoneum and surgery (PnS) society. World J Emerg Surg. 2010 Dec 28;5:29. doi: 10.1186/1749-7922-5-29. PMID: 21189148; PMCID: PMC3022691. van Hooft JE, Veld JV, Arnold D, Beets-Tan RGH, Everett S, Götz M, van Halsema EE, Hill J, Manes G, Meisner S, Rodrigues-Pinto E, Sabbagh C, Vandervoort J, Tanis PJ, Vanbiervliet G, Arezzo A. Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2020. Endoscopy. 2020 May;52(5):389-407. doi: 10.1055/a-1140-3017. Epub 2020 Apr 7. PMID: 32259849. Alenezi A, McGrath I, Kimpton A, Livesay K. Quality of life among ostomy patients: A narrative literature review. J Clin Nurs. 2021 Nov;30(21-22):3111-3123. doi: 10.1111/jocn.15840. Epub 2021 May 12. PMID: 33982291. Aoyama T, Oba K, Honda M, Muto M, Mayanagi S, Maeda H, Kanda M, Kashiwabara K, Sakamoto J, Yoshikawa T. The clinical impacts of postoperative complications after colon cancer surgery for the clinical course of adjuvant treatment and survival. Int J Clin Oncol. 2023 Jun;28(6):777-784. doi: 10.1007/s10147-023-02332-y. Epub 2023 Apr 11. PMID: 37039949; PMCID: PMC10232630. Öistämö E, Hjern F, Blomqvist L, Falkén Y, Pekkari K, Abraham-Nordling M. Emergency management with resection versus proximal stoma or stent treatment and planned resection in malignant left-sided colon obstruction. World J Surg Oncol. 2016 Aug 30;14(1):232. doi: 10.1186/s12957-016-0994-2. PMID: 27577887; PMCID: PMC5006427. Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation--technical notes and outcome. Colorectal Dis. 2009 May;11(4):354-64; discussion 364-5. doi: 10.1111/j.1463-1318.2008.01735.x. Epub 2009 Nov 5. PMID: 19016817. Mabardy A, Miller P, Goldstein R, Coury J, Hackford A, Dao H. Stenting for obstructing colon cancer: fewer complications and colostomies. JSLS. 2015 Jan-Mar;19(1):e2014.00254. doi: 10.4293/JSLS.2014.00254. PMID: 25848200; PMCID: PMC4379870. Zhang J, Deng J, Hu J, Zhong Q, Li J, Su M, Liu W, Lv M, Xu T, Lin D, Guo X. Safety and feasibility of neoadjuvant chemotherapy as a surgical bridge for acute left-sided malignant colorectal obstruction: a retrospective study. BMC Cancer. 2022 Jul 21;22(1):806. doi: 10.1186/s12885-022-09906-5. PMID: 35864459; PMCID: PMC9306149. Veld JV, Amelung FJ, Borstlap WAA, van Halsema EE, Consten ECJ, Siersema PD, Ter Borg F, van der Zaag ES, de Wilt JHW, Fockens P, Bemelman WA, van Hooft JE, Tanis PJ; Dutch Snapshot Research Group. Comparison of Decompressing Stoma vs Stent as a Bridge to Surgery for Left-Sided Obstructive Colon Cancer. JAMA Surg. 2020 Mar 1;155(3):206-215. doi: 10.1001/jamasurg.2019.5466. Erratum in: JAMA Surg. 2020 Mar 1;155(3):269. doi: 10.1001/jamasurg.2020.0131. PMID: 31913422; PMCID: PMC6990965. Hong SP, Kim TI. Colorectal stenting: an advanced approach to malignant colorectal obstruction. World J Gastroenterol. 2014 Nov 21;20(43):16020-8. doi: 10.3748/wjg.v20.i43.16020. PMID: 25473154; PMCID: PMC4239488. van Hooft JE, Bemelman WA, Oldenburg B, Marinelli AW, Lutke Holzik MF, Grubben MJ, Sprangers MA, Dijkgraaf MG, Fockens P; collaborative Dutch Stent-In study group. Colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a multicentre randomised trial. Lancet Oncol. 2011 Apr;12(4):344-52. doi: 10.1016/S1470-2045(11)70035-3. Erratum in: Lancet Oncol. 2011 May;12(5):418. PMID: 21398178. Kong JC, Lee J, Gosavi R, Ngan SY, Tillman MM, Bednarski BK, Heriot AG, Chang GJ, Warrier SK. Is neoadjuvant therapy an alternative strategy to immediate surgery in locally perforated colon cancer? Colorectal Dis. 2021 Dec;23(12):3162-3172. doi: 10.1111/codi.15868. Epub 2021 Aug 28. PMID: 34379861. Low DE, Panto PN, Hastings AG, Nigam K. An unusual complication of a colonic wallstent. Cardiovasc Intervent Radiol. 2004 Jul-Aug;27(4):377-8. doi: 10.1007/s00270-004-0195-1. Epub 2004 Jun 16. PMID: 15346212. Mauro A, Scalvini D, Borgetto S, Fugazzola P, Mazza S, Perretti I, Gallotti A, Pagani A, Ansaloni L, Anderloni A. Malignant Acute Colonic Obstruction: Multidisciplinary Approach for Endoscopic Management. Cancers (Basel). 2024 Feb 18;16(4):821. doi: 10.3390/cancers16040821. PMID: 38398212; PMCID: PMC10887189. Tanaka A, Sadahiro S, Yasuda M, Shimizu S, Maeda Y, Suzuki T, Tokunaga N, Ogoshi K. Endoscopic balloon dilation for obstructive colorectal cancer: a basic study on morphologic and pathologic features associated with perforation. Gastrointest Endosc. 2010 Apr;71(4):799-805. doi: 10.1016/j.gie.2009.10.059. PMID: 20363422. Datye A, Hersh J. Colonic perforation after stent placement for malignant colorectal obstruction--causes and contributing factors. Minim Invasive Ther Allied Technol. 2011 May;20(3):133-40. doi: 10.3109/13645706.2010.518787. Epub 2010 Oct 8. PMID: 20929424. Mauro A, Scalvini D, Borgetto S, Fugazzola P, Mazza S, Perretti I, Gallotti A, Pagani A, Ansaloni L, Anderloni A. Malignant Acute Colonic Obstruction: Multidisciplinary Approach for Endoscopic Management. Cancers (Basel). 2024 Feb 18;16(4):821. doi: 10.3390/cancers16040821. PMID: 38398212; PMCID: PMC10887189. Cennamo V, Fuccio L, Mutri V, Minardi ME, Eusebi LH, Ceroni L, Laterza L, Ansaloni L, Pinna AD, Salfi N, Martoni AA, Bazzoli F. Does stent placement for advanced colon cancer increase the risk of perforation during bevacizumab-based therapy? Clin Gastroenterol Hepatol. 2009 Nov;7(11):1174-6. doi: 10.1016/j.cgh.2009.07.015. Epub 2009 Jul 22. PMID: 19631290. Fuccio L, Correale L, Arezzo A, Repici A, Manes G, Trovato C, Mangiavillano B, Manno M, Cortelezzi CC, Dinelli M, Cennamo V, de Bellis M; KRASTENT Study Group. Influence of K-ras status and anti-tumour treatments on complications due to colorectal self-expandable metallic stents: a retrospective multicentre study. Dig Liver Dis. 2014 Jun;46(6):561-7. doi: 10.1016/j.dld.2014.02.006. Epub 2014 Mar 14. PMID: 24630948. Sebastian S, Johnston S, Geoghegan T, Torreggiani W, Buckley M. Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol. 2004 Oct;99(10):2051-7. doi: 10.1111/j.1572-0241.2004.40017.x. PMID: 15447772. Lee KM, Shin SJ, Hwang JC, Cheong JY, Yoo BM, Lee KJ, Hahm KB, Kim JH, Cho SW. Comparison of uncovered stent with covered stent for treatment of malignant colorectal obstruction. Gastrointest Endosc. 2007 Nov;66(5):931-6. doi: 10.1016/j.gie.2007.02.064. Epub 2007 Sep 4. PMID: 17767930. Han SH, Lee JH. Colonic stent-related complications and their management. Clin Endosc. 2014 Sep;47(5):415-9. doi: 10.5946/ce.2014.47.5.415. Epub 2014 Sep 30. PMID: 25325000; PMCID: PMC4198557. Dharmadhikari R, Nice C. Complications of colonic stenting: a pictorial review. Abdom Imaging. 2008 May-Jun;33(3):278-84. doi: 10.1007/s00261-007-9240-2. PMID: 17505852. Park S, Cheon JH, Park JJ, Moon CM, Hong SP, Lee SK, Kim TI, Kim WH. Comparison of efficacies between stents for malignant colorectal obstruction: a randomized, prospective study. Gastrointest Endosc. 2010 Aug;72(2):304-10. doi: 10.1016/j.gie.2010.02.046. Epub 2010 Jun 19. PMID: 20561619. Lee JS, Lee HS, Kim ES, Jung MK, Jung JT, Kim HG, Lee DW, Kim DJ, Lee YJ, Yang CH; Daegu-Gyeongbuk Gastrointestinal Study Group (DGSG). Comparison of different types of covered self-expandable metal stents for malignant colorectal obstruction. Surg Endosc. 2021 Aug;35(8):4124-4133. doi: 10.1007/s00464-020-07869-x. Epub 2020 Aug 13. PMID: 32789723. Foo CC, Poon SHT, Chiu RHY, Lam WY, Cheung LC, Law WL. Is bridge to surgery stenting a safe alternative to emergency surgery in malignant colonic obstruction: a meta-analysis of randomized control trials. Surg Endosc. 2019 Jan;33(1):293-302. doi: 10.1007/s00464-018-6487-3. Epub 2018 Oct 19. PMID: 30341649. Yamashita S, Tanemura M, Sawada G, Moon J, Shimizu Y, Yamaguchi T, Kuwai T, Urata Y, Kuraoka K, Hatanaka N, Yamashita Y, Taniyama K. Impact of endoscopic stent insertion on detection of viable circulating tumor cells from obstructive colorectal cancer. Oncol Lett. 2018 Jan;15(1):400-406. doi: 10.3892/ol.2017.7339. Epub 2017 Nov 2. PMID: 29391884; PMCID: PMC5769419. Alotaibi AM, Lee JL, Kim J, Lim SB, Yu CS, Kim TW, Kim JH, Kim JC. Prognostic and Oncologic Significance of Perineural Invasion in Sporadic Colorectal Cancer. Ann Surg Oncol. 2017 Jun;24(6):1626-1634. doi: 10.1245/s10434-016-5748-4. Epub 2017 Jan 9. PMID: 28070726. Benson AB 3rd, Venook AP, Cederquist L, Chan E, Chen YJ, Cooper HS, Deming D, Engstrom PF, Enzinger PC, Fichera A, Grem JL, Grothey A, Hochster HS, Hoffe S, Hunt S, Kamel A, Kirilcuk N, Krishnamurthi S, Messersmith WA, Mulcahy MF, Murphy JD, Nurkin S, Saltz L, Sharma S, Shibata D, Skibber JM, Sofocleous CT, Stoffel EM, Stotsky-Himelfarb E, Willett CG, Wu CS, Gregory KM, Freedman-Cass D. Colon Cancer, Version 1.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2017 Mar;15(3):370-398. doi: 10.6004/jnccn.2017.0036. PMID: 28275037. Hu Y, Fan J, Xv Y, Hu Y, Ding Y, Jiang Z, Tao Q. Comparison of safety between self-expanding metal stents as a bridge to surgery and emergency surgery based on pathology: a meta-analysis. BMC Surg. 2020 Oct 27;20(1):255. doi: 10.1186/s12893-020-00908-3. PMID: 33109142; PMCID: PMC7592574 Balciscueta I, Balciscueta Z, Uribe N, García-Granero E. Perineural invasion is increased in patients receiving colonic stenting as a bridge to surgery: a systematic review and meta-analysis. Tech Coloproctol. 2021 Feb;25(2):167-176. doi: 10.1007/s10151-020-02350-2. Epub 2020 Nov 17. PMID: 33200308. Charles S, François B, Momar D, et al. Is stenting as "a bridge to surgery" an oncologically safe strategy for the management of acute, left-sided, malignant, colonic obstruction? A comparative study with a propensity score analysis. Ann Surg 2013;258(1) doi: 10.1097/SLA.0b013e31827e30ce Morton D, Seymour M, Magill L, Handley K, Glasbey J, Glimelius B, Palmer A, Seligmann J, Laurberg S, Murakami K, West N, Quirke P, Gray R; FOxTROT Collaborative Group. Preoperative Chemotherapy for Operable Colon Cancer: Mature Results of an International Randomized Controlled Trial. J Clin Oncol. 2023 Mar 10;41(8):1541-1552. doi: 10.1200/JCO.22.00046. Epub 2023 Jan 19. PMID: 36657089; PMCID: PMC10022855. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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2","display":"","copyAsset":false,"role":"figure","size":353756,"visible":true,"origin":"","legend":"\u003cp\u003eDisease-free survival curves of patients in the SEMS-surgery group and SEMS-neoadjuvant-surgery group\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6830907/v1/a705ebda4ba390f952ccb369.jpg"},{"id":85742000,"identity":"ec0a6cb6-2067-40b4-8948-73e0c2f5ac6d","added_by":"auto","created_at":"2025-07-01 09:01:54","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":240608,"visible":true,"origin":"","legend":"\u003cp\u003eCox regression analysis of patients’ overall survival in the SEMS-surgery group and SEMS-neoadjuvant-surgery group\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6830907/v1/d223792141004009e5af91a6.jpg"},{"id":85741997,"identity":"589019da-cf03-49cf-91c4-ef5b475b5280","added_by":"auto","created_at":"2025-07-01 09:01:54","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":234790,"visible":true,"origin":"","legend":"\u003cp\u003eCox regression analysis of patients’ disease-free survival in the SEMS-surgery group and SEMS-neoadjuvant-surgery group\u003c/p\u003e","description":"","filename":"Figure4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6830907/v1/4ea60026746fa71babaa8ff0.jpg"},{"id":101305284,"identity":"03c7537c-83b1-412d-ae6f-a2f79255b777","added_by":"auto","created_at":"2026-01-28 10:05:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2131407,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6830907/v1/f4e66107-873b-4495-8464-bc78775df036.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"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","fulltext":[{"header":"Introduction","content":"\u003cp\u003eColorectal cancer represents approximately 10% of all cancer diagnoses globally each year\u003csup\u003e1\u003c/sup\u003e. Of these, about 4%-22% of patients present with acute intestinal obstruction as their initial symptom\u003csup\u003e2\u003c/sup\u003e. While emergency surgery remains the primary treatment for acute complete obstructive left-sided colon cancer, clinical practice has shown that self-expanding metallic stents (SEMS) can be significantly effective. SEMS can relieve acute obstruction and convert emergency surgery into a staged operation, providing patients with a critical time window to correct fluid imbalances, receive nutritional support, and restore cardiopulmonary function\u003csup\u003e3 4\u003c/sup\u003e. Numerous studies have reported that SEMS have a high clinical and technical success rate, which can improve primary anastomosis rates, reduce postoperative complications, and exhibit favorable short-term outcomes. As a result, SEMS has been widely used in treating complete obstructive colon cancer\u003csup\u003e5-8\u003c/sup\u003e, although its long-term efficacy remains controversial\u003csup\u003e9 10\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eSome studies suggest that SEMS placement can lead to tumor compression and mechanical pressure on the intestine, potentially causing tumor cell dissemination, colon perforation, and other complications\u003csup\u003e11 12\u003c/sup\u003e. Therefore, our center proposes performing neoadjuvant chemotherapy after SEMS placement to appropriately extend the preoperative waiting time. This method enhances the patient\u0026apos;s overall health and local bowel environment while also aiding in the control of local tumors and potential metastatic lesions, thereby increasing the effectiveness and radicality of the surgery\u003csup\u003e7 13\u003c/sup\u003e. Preliminary retrospective studies have shown that the SEMS-neoadjuvant-surgery strategy can improve the surgical outcomes of completely obstructive left-sided colon cancer, with no local recurrence or distant metastasis observed during a 3-year follow-up period\u003csup\u003e7\u003c/sup\u003e. Based on these findings, the present study aims to evaluate the impact of SEMS combined with neoadjuvant chemotherapy on perioperative complications in patients with complete obstructive left-sided colon cancer using a larger sample size. It will also explore the management of SEMS-related complications and further compare the long-term (5-year) oncological outcomes of the SEMS-surgery versus SEMS-neoadjuvant-surgery strategies, to investigate the clinical application value of SEMS placement combined with neoadjuvant chemotherapy.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA retrospective analysis was conducted on the clinical data of patients with complete obstructive left-sided colon cancer treated in the Department of General Surgery at Beijing Chaoyang Hospital, Capital Medical University, from January 2014 to May 2023. The inclusion criteria were as follows:\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e1. Diagnosis of complete left-sided colon obstruction based on clinical manifestations and imaging examinations; 2. Pathological confirmation of colonic adenocarcinoma; 3. Tumor located in the left-sided colon, from the splenic flexure to more than 15 cm from the anus; 4. Ability to tolerate SEMS placement. The exclusion criteria were as follows: 1.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ePatients who did not undergo surgical treatment after SEMS placement; 2. Presence of distant metastasis at the time of diagnosis; 3.Familial adenomatous polyposis; 4. Incomplete clinical data; 5. Loss to follow-up.\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of Beijing Chaoyang Hospital, Capital Medical University (Approval No: 2016-Ke-161-1). All procedures involving human participants were in accordance with the ethical standards of the 1964 Helsinki declaration and its later amendments. Written informed consent was obtained from all individual participants included in the study. This study was registered at ClinicalTrials.gov (Identifier: NCT02972541) Beijing Chao Yang Hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTreatment Methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(1) \u003cstrong\u003eSEMS-surgery group\u003c/strong\u003e: SEMS placement was performed by gastroenterologists under endoscopic guidance with a guidewire to relieve acute obstruction. Active treatment included anti-inflammatory therapy, acid suppression, and intravenous nutritional support. Nutritional support was gradually transitioned from intravenous to enteral nutrition. SEMS was left in place for about 2 weeks, and after the patient\u0026rsquo;s condition stabilized, radical surgery was performed\u003csup\u003e14\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e(2) \u003cstrong\u003eSEMS-neoadjuvant-surgery group\u003c/strong\u003e: Gastroenterologists performed the endoscopic examination and biopsy for pathological examination, followed by SEMS placement under endoscopic guidance to relieve acute obstruction. After the obstruction was relieved, patients underwent two cycles of CAPEOX (Oxaliplatin + Capecitabine) or three cycles of mFOLFOX6 (Oxaliplatin + Leucovorin + 5-Fluorouracil) chemotherapy. After completing neoadjuvant chemotherapy, surgery was performed 2\u0026ndash;3 weeks later.\u003c/p\u003e\n\u003cp\u003eAll patients were given adjuvant chemotherapy based on postoperative pathological results and personal preferences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObservation Indicators\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(1) \u003cstrong\u003ePrimary Outcome Indicators\u003c/strong\u003e: 5-year overall survival (OS), disease-free survival (DFS), and SEMS-related complication rates (perforation, re-obstruction, migration, and unresolved obstruction). OS is defined as the time from radical surgery until death or the end of follow-up; DFS is defined as the time from radical surgery until tumor metastasis, recurrence, death, or the end of follow-up. Re-obstruction is defined as a narrowing or complete obstruction of the SEMS placement site after SEMS relief, leading to a failure of the expected passage of intestinal contents.\u003c/p\u003e\n\u003cp\u003e(2) \u003cstrong\u003eSecondary Outcome Indicators\u003c/strong\u003e: 5-year distant metastasis rate, 5-year local recurrence rate, laparoscopic surgery proportion, surgery duration, intraoperative blood loss, number of lymph nodes retrieved, number of positive lymph nodes retrieved, postoperative hospital stay, ileostomy rate, postoperative early complication rate, and complication severity. Postoperative early complications are any clinical conditions occurring within 30 days after surgery that require prolonged hospitalization or deviate from the normal postoperative course. Postoperative complications were graded according to the Clavien-Dindo classification system\u003csup\u003e15\u003c/sup\u003e:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFollow-up and data collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePostoperative follow-up was conducted through outpatient visits and telephone follow-ups. Telephone follow-ups were conducted before outpatient visits to inquire about the patient\u0026apos;s health status and remind them of the upcoming appointment. Outpatient visits were every 3 months for the first 2 years, then every 6 months for 5 years. The endpoint event for follow-up was defined as the occurrence of tumor metastasis, recurrence, or death. The follow-up period was until May 2024.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eComparisons of baseline characteristics and the postoperative outcomes were performed by the Mann\u0026ndash;Whitney U test and independent t-tests for continuous variables and the x\u0026sup2; test for categorical variables. Fisher\u0026rsquo;s exact test compared all categorical variables. Disease-free and overall survival were estimated using the Kaplan\u0026ndash;Meier method, comparing treatment groups using the Log-rank test. Cox regression analysis was used to identify independent risk factors affecting patient survival prognosis. A two-sided p-value of less than 0.05 was considered statistically significant. Statistical analysis was performed using SPSS 27.0.1 (IBM, USA).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eBaseline Data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 106 patients with complete obstructive left-sided colon cancer were initially included. After excluding 24 patients (14 lost to follow-up, 8 with distant metastasis at initial diagnosis, and 2 with incomplete clinical data), 82 were ultimately enrolled in the study. The treatment strategies included the SEMS-surgery approach in 35 cases and the SEMS-neoadjuvant-surgery approach in 47 cases. All patients were followed up, with a median follow-up time of 55 (12\u0026ndash;112) months. The median follow-up time for the SEMS-surgery group was 73 (17\u0026ndash;112) months, while the median follow-up time for the SEMS-neoadjuvant-surgery group was 46 (12\u0026ndash;106) months. The median age of patients in both groups was 67.8 years, with the most common tumor location being the sigmoid colon. Except for the preoperative waiting time, other indicators had no statistically significant differences (P \u0026gt; 0.05). The preoperative waiting time for the SEMS-neoadjuvant-surgery group was significantly longer than that of the SEMS-surgery group(75.2 \u0026plusmn; 38.4 days vs. 29.3 \u0026plusmn; 27.5 days, P = 0.001), which is shown in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison of intraoperative indicators and postoperative pathological findings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCompared to the SEMS-surgery group, the SEMS-neoadjuvant-surgery group had a higher proportion of laparoscopic surgeries (89.4% vs. 65.7%, P = 0.007), shorter postoperative hospital stays (10.0 \u0026plusmn; 3.3 days vs. 13.5 \u0026plusmn; 5.3 days, P = 0.001), and lower ileostomy rates (10.6% vs. 28.6%, P = 0.038). There were no statistically significant differences between the two groups regarding surgery duration and blood loss (P \u0026gt; 0.05). Postoperative pathological results showed that the number of lymph nodes retrieved in the SEMS-neoadjuvant-surgery group was significantly higher (30.3 \u0026plusmn; 16.0 vs. 23.0 \u0026plusmn; 10.0, P=0.021). Still, there was no significant difference in the number of positive lymph nodes (P \u0026gt; 0.05). Results are shown in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePostoperative Complications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of twenty patients (24.4%) developed early postoperative complications within 30 days. The SEMS-neoadjuvant-surgery group (seven cases) had a significantly lower early complication rate compared to the SEMS-surgery group (thirteen cases) (14.9% vs. 37.1%, P = 0.020). A total of thirty early postoperative complications occurred in twenty patients, with the SEMS-neoadjuvant-surgery group having ten and the SEMS-surgery group having twenty. Among the SEMS-neoadjuvant-surgery group, two patients had more than two complications, while seven patients in the SEMS-surgery group had more than two complications. The most common early postoperative complications in the SEMS-surgery group were lung infections (25.7%) and wound infections (20.0%). The SEMS-neoadjuvant-surgery group had significantly lower rates of wound infection (4.3% vs. 20.0%, P = 0.029) and lung infection (6.4% vs. 25.7%, P = 0.014) compared to the SEMS-surgery group. No significant differences were found in other postoperative complication rates (P \u0026gt; 0.05). There were no significant differences in the severity of postoperative complications between the two groups (P \u0026gt; 0.05). Results are shown in Table 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSEMS and Chemotherapy-Related Complications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThirteen patients (15.9%) developed SEMS-related complications after SEMS placement but before surgery. Among them, six cases (7.3%) experienced perforation, with 3 cases in the SEMS-surgery group(6.4%) and 3 cases in the SEMS-neoadjuvant-surgery group(8.6%). Re-obstruction occurred in five cases (6.1%), with 3 cases in the SEMS-surgery group(6.4%) and 2 cases in the SEMS-neoadjuvant-surgery group(5.7%). One SEMS migration (1.2%) in the SEMS-neoadjuvant-surgery group and one unresolved obstruction (1.2%) occurred in the SEMS-surgery group (2.9%) after SEMS placement. No bone marrow suppression was observed in the patients undergoing neoadjuvant chemotherapy.\u003c/p\u003e\n\u003cp\u003eCompared to the SEMS-surgery group, the SEMS-neoadjuvant-surgery group had no significant differences in the overall rate of SEMS-related complications (14.9% vs. 17.1%, P = 0.783), perforation rate (6.4% vs. 8.6%, P = 1.000), re-obstruction rate (6.4% vs. 5.7%, P = 1.000), migration rate (2.0% vs. 0.0%, P = 1.000), or unresolved obstruction rate (0.0% vs. 2.3%, P = 0.427). Results are shown in Table 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLong-Term Efficacy Comparison\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe 5-year OS (78.3% vs. 51.7%, P = 0.048) and 5-year DFS (73.9% vs. 41.4%, P = 0.019) were all significantly higher in the SEMS-neoadjuvant-surgery group compared to the SEMS-surgery group, with statistical significance. Results are shown in Table 3.\u003c/p\u003e\n\u003cp\u003eKaplan-Meier survival analysis showed that the median survival time for the SEMS-surgery group was 70.5 (95% CI 52.6\u0026ndash;88.4) months, while the median survival time for the SEMS-neoadjuvant-surgery group was 90.3 (95% CI 76.1\u0026ndash;104.6) months. The median disease-free survival time for the SEMS-surgery group was 65.3 (95% CI 47.3\u0026ndash;83.2) months, while the median disease-free survival time for the SEMS-neoadjuvant-surgery group was 94.2 (95% CI 81.0\u0026ndash;107.3) months. Log-rank test results showed significant differences between the two groups\u0026apos; median survival and disease-free survival times (P = 0.029, 0.007). Results are shown in Figures 1 and 2.\u003c/p\u003e\n\u003cp\u003eCox regression analysis showed that for patients with obstructive left colon cancer, \u0026nbsp;immediate surgery after SEMS placement (SEMS-surgery approach) was an independent risk factor for OS (HR=0.401, 95% CI: 0.174\u0026ndash;0.926, P=0.032) and DFS (HR=0.394, 95% CI: 0.184\u0026ndash;0.843, P=0.016), In cox regression analysis, SEMS-related complications emerged as an independent risk factor for OS (HR=0.325, 95% CI: 0.121-0.868; P=0.025) but showed no significant association with DFS (P=0.066). Results are shown in Figures 3 and 4.\u003c/p\u003e\n\u003cp\u003eAfter excluding patients with follow-up times \u0026lt; 5 years, the 5-year OS (87.5% vs. 57.1%, P = 0.045) and 5-year DFS (81.3% vs. 47.6%, P = 0.037) in the SEMS-neoadjuvant-surgery group remained higher than those in the SEMS-surgery group, with statistically significant differences.\u003c/p\u003e\n\u003cp\u003eAmong all cases, six patients (7.3%) developed local tumor recurrence within 5 years postoperatively, and eighteen patients (22.0%) developed distant metastasis within 5 years postoperatively. The 5-year local recurrence rate and distant metastasis rate in the SEMS-neoadjuvant-surgery group were lower than those in the SEMS-surgery group, with statistically significant differences (P \u0026lt; 0.05). Results are shown in Table 3.\u003c/p\u003e\n\u003cp\u003eThe 47 patients who received the SEMS-neoadjuvant treatment plan were divided into two subgroups based on whether they received CAPEOX (31 patients) or mFOLFOX6 (16 patients). There were no statistically significant differences between the two subgroups in the 5-year local recurrence rate (3.2% vs. 0.0%, P = 0.468), 5-year metastasis rate (9.7% vs. 18.8%, P = 0.377), 5-year OS (78.6% vs. 77.8%, P = 0.964), or 5-year DFS (71.4% vs. 77.8%, P = 0.735).\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"669\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 669px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1:\u003c/strong\u003e Baseline data and surgical outcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eSEMS-surgery group\u003c/p\u003e\n \u003cp\u003e（n=35）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eSEMS-neoadjuvant-surgery group（n=47）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003estatistical value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eP-Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.724\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eMale，（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e21（60.0%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e30（63.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eFemale，（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e14（40.0%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e17（36.2%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eAge，（year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e68.8\u0026plusmn;11.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e66.8\u0026plusmn;10.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e1.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.319\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eBMI，(kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e22.4\u0026plusmn;3.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e22.3\u0026plusmn;3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.867\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eComorbidities，（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e19（54.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e16（34.0%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e2.584\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.108\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Diabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e2（5.7%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e7（14.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e1.730\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.188\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Coronary Artery Disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e2（5.7%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e4（8.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.231\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.631\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eASA Score，（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2.214\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.330\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e20（57.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e32（68.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;3\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e12（34.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e14（29.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;4\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e3（8.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1（2.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eTumor Location，（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.080\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.897\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Transverse Colon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e3（8.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e2（4.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Splenic Flexure of Colon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e2（5.7%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e3（6.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Descending Colon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e7（20.0%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e11（23.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Sigmoid Colon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e23（65.7%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e31（66.0%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eT Stage，（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.981\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.322\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;T3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e17（48.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e28（59.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;T4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e18（51.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e19（40.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eN Stage，（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.308\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.857\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;N0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e18（51.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e24（51.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;N1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e12（34.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e18（38.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;N2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e5（14.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e5（10.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eTNM Stage，（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.974\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Stage II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e18（51.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e24（51.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Stage III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e17（48.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e23（48.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eDifferentiation Grade，（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2.492\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.288\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Well-differentiated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0（0.0%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1（2.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Moderately differentiated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e32（91.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e45（95.7%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Poorly differentiated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e3（8.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1（2.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eHemoglobin，（g/l）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e107.6\u0026plusmn;16.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e103.0\u0026plusmn;16.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e1.221\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.226\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003ePlatelets，（10\u003csup\u003e9\u003c/sup\u003e/L）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e232.0\u0026plusmn;70.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e205.8\u0026plusmn;68.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e1.659\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.101\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eCreatinine，（umol/l）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e61.5\u0026plusmn;15.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e54.8\u0026plusmn;18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e1.822\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.072\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eAlbumin，（g/l）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e30.9\u0026plusmn;7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e32.4\u0026plusmn;7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e-0.941\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.349\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eALT，（U/L）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e18.5\u0026plusmn;14.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e16.3\u0026plusmn;9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.841\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.403\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eAST，（U/L）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e21.6\u0026plusmn;10.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e22.4\u0026plusmn;10.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e-0.337\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.737\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eLymphocytes，（10\u003csup\u003e9\u003c/sup\u003e/l）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1.0\u0026plusmn;0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1.1\u0026plusmn;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e-0.563\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.575\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eNeutrophils，（10\u003csup\u003e9\u003c/sup\u003e/L）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e8.3\u0026plusmn;3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e7.4\u0026plusmn;2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e1.429\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.157\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003ePreoperative Waiting Time\u0026nbsp;，（Weeks）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e3.3\u0026plusmn;3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e10.6\u0026plusmn;5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e44.923\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003ePostoperative Adjuvant Chemotherapy，（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e20（57.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e33（70.2%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e1.499\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.221\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eSurgical Approach，（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 85px;\"\u003e\n \u003cp\u003e7.179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.007\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Laparoscopy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e23（65.7%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e42（89.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Open Surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e12（34.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e5（10.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eSurgical Time，（min）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e205（180~254）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e200（170~225）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.506\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.614\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eBlood Loss，（ml）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e149.4\u0026plusmn;138.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e135.3\u0026plusmn;114.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.491\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.625\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eLymph Node Retrieval,（Count）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e23.0\u0026plusmn;10.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e30.3\u0026plusmn;16.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e-2.359\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.021\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003ePositive Lymph Node Retrieval\u0026nbsp;（Count）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.5（0.0~3.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.0（0.0~2.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.427\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.513\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003ePostoperative Hospital Stay，（Days）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e13.5\u0026plusmn;5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e10.0\u0026plusmn;3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e8.096\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eIleostomy Rate，（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e10（28.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e5（10.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e4.316\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.037\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u003c/strong\u003e Comparison of complication rates of patients after SEMS placement\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"669\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eComplications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eSEMS-surgery group\u003c/p\u003e\n \u003cp\u003e（n=35）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eSEMS-neoadjuvant-surgery group（n=47）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003estatistical value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eP-Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eSEMS-related complications rate，（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e6（17.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e7（14.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.076\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.783\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Perforation，（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e3（8.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e3（6.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Re-obstruction，（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e2（5.7%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e3（6.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Displacement，（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0（0.0%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1（2.0%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.754\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Unresolved obstruction，（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e1（2.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0（0.0%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e1.359\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.427\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003ePostoperative early complications rate，（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e13（37.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e7（14.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e5.385\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.020\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Incision infection，（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e7（20.0%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e2（4.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e5.090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.029\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Pulmonary infection, （%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e9（25.7%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e3（6.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e6.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.014\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Postoperative bowel obstruction，（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e2（5.7%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1（2.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.732\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.392\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Lower extremity venous thrombosis，（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e2（5.7%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0（0.0%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e2.753\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.097\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Gastric paralysis，（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0（0.0%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1（2.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.754\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Urinary tract infection，（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0（0.0%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1（2.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.754\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Septicemia,（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0（0.0%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1（2.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.754\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Anastomotic leakage，（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0（0.0%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1（2.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.754\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003ePostoperative complications grade，（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e13（100%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e7（100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 85px;\"\u003e\n \u003cp\u003e3.263\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.353\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Grade 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e10（76.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e3（42.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Grade 2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e2（15.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e2（28.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Grade 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0（0.0%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1（14.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Grade 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e1（7.7%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1（14.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe SEMS-surgery group had thirteen patients with twenty postoperative early complications, while the SEMS-neoadjuvant-surgery group had seven patients with ten postoperative early complications.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u003c/strong\u003e Long-term survival outcomes of patients after SEMS placement.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"669\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eOutcome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eSEMS-surgery group\u003c/p\u003e\n \u003cp\u003e（n=35）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eSEMS-neoadjuvant-surgery group（n=47）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003estatistical value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eP-Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e5-year Overall Survival Rate，（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e15（51.7%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e18（78.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e3.895\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.048\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e5-year Disease-Free Survival Rate,（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e12（41.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e17（73.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e5.504\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.019\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e5-year Local Recurrence Rate，（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e5（14.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1（2.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e4.373\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.037\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e5-year Distant Metastasis Rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e12（34.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e6（12.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e5.423\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.020\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe use of SEMS for the treatment of completely obstructive left-sided colon cancer was first reported in 1994\u003csup\u003e16\u003c/sup\u003e. The placement of SEMS provides patients with acute intestinal obstruction an opportunity to convert emergency surgery into elective surgery\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. SEMS has gradually become an alternative treatment for emergency surgery\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e, which has been widely applied in treating obstructive colon cancer \u003csup\u003e\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. Our study showed that compared to the SEMS-surgery group, the SEMS-neoadjuvant-surgery group significantly increased the proportion of laparoscopic surgeries, the number of lymph nodes detected, as well as 5-year OS, and DFS, shortened postoperative hospital stay, and reduced the rates of ileostomy, early postoperative complications, and 5-year local recurrence and distant metastasis. This confirms the short-term surgical and long-term oncological effectiveness of elective surgery for completely obstructive left-sided colon cancer after SEMS placement combined with neoadjuvant chemotherapy.\u003c/p\u003e \u003cp\u003eThe rate of stoma formation and postoperative complications is closely linked to the patient's quality of life after surgery\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. Studies indicate that using SEMS as a bridge to surgery can shorten hospital stays, reduce ileostomy rates, and lower postoperative complications compared to emergency surgery\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. SEMS allows for improved patient conditions and reduced bowel wall edema, enhancing the safety of primary anastomosis\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. However, some studies suggest that even with surgery two weeks after SEMS placement, bowel wall edema can persist, and ileostomy rates remain high at 29.1%\u003csup\u003e27 28\u003c/sup\u003e. In our research, the SEMS-neoadjuvant-surgery group, with a preoperative waiting time of 10 weeks, had a much lower ileostomy rate of 10.6%, shorter hospital stays, and fewer complications. This suggests extending the waiting time after SEMS placement can improve patient outcomes. We believe this finding is also associated with the significantly increased lymph node yield observed in the SEMS-neoadjuvant-surgery group. Previous studies have identified several key factors contributing to low lymph node retrieval, including intraoperative bowel wall edema, poor surgical field visualization, and a high proportion of palliative surgeries\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. The SEMS-neoadjuvant-surgery strategy extends the preoperative waiting period, improves patient conditions, and consequently leads to a marked increase in lymph node harvest.\u003c/p\u003e \u003cp\u003ePerforation is the most common and serious complication occurring within the first two weeks after SEMS placement, often leading to acute peritonitis and requiring emergency surgery\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. This complication is typically caused by reduced luminal compliance and the expansion force of the SEMS\u003csup\u003e\u003cspan additionalcitationids=\"CR32\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e. The decrease in luminal compliance is influenced by factors such as increased collagen fibers around the tumor and reduced smooth muscle cells due to tumor invasion, alongside severe stenosis from tumor growth, further narrowing the intestinal diameter\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. Consequently, significant collagen proliferation and severe stenosis can help predict perforations\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e. In our study, most perforations also occurred within two weeks post-SEMS placement, suggesting that a preoperative waiting period for neoadjuvant chemotherapy may not considerably raise the risk of perforation. Notably, 83.3% of perforations occurred at the proximal flared end of the SEMS, likely due to the expansion force and sharp edges, combined with intestinal peristalsis and the pressure from intestinal contents, creating tremendous stress on the intestinal wall. Research shows that the risk of colon perforation is nearly three times higher in patients treated with bevacizumab after SEMS placement\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e. Bevacizumab may lead to perforation by promoting tumor regression that penetrates the colon's serosal layer or by causing local ischemia and hindering ulcer healing\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e. Our study noted one case of perforation after bevacizumab use. While some studies suggest that bevacizumab doesn't significantly increase the risk of perforation and may prolong survival when combined with chemotherapy\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e, it is still advisable to avoid its use during neoadjuvant chemotherapy after SEMS placement when possible.\u003c/p\u003e \u003cp\u003eTumor overgrowth into the intestinal lumen is the leading cause of re-obstruction, along with fecal impaction and mucosal prolapse\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e. Research shows that SEMS primarily enlarges the bowel lumen but does not prevent tumor growth, especially with uncovered stents, which allow tumor cells to invade the mesh\u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e. As a result, re-obstructions often happen weeks after SEMS placement, aligning with the findings of our study. Some studies suggest that re-obstruction may be linked to fecal impaction. This occurs when consuming high-fiber, residue-rich, and difficult-to-digest foods leads to stool accumulation within the stent lumen, resulting in obstruction\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e. Therefore, advising patients to eat easily digestible, low-residue foods, along with using laxatives, may help decrease the occurrence of re-obstruction after the placement of SEMS\u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eStudies indicate that covered stents have a migration rate of 11.8%\u003csup\u003e39\u003c/sup\u003e, primarily because they are harder to anchor securely, making them vulnerable to displacement from tumor pressure and intestinal movement\u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e. At our center, we use uncovered stents, which reduce the risk of migration despite a slightly higher chance of re-obstruction\u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e. Further research is needed to explore the relationship between covered and uncovered stents regarding these risks.\u003c/p\u003e \u003cp\u003eA meta-analysis found that SEMS-surgery has a higher overall recurrence rate than emergency surgery (37.0% vs. 25.9%, P\u0026thinsp;=\u0026thinsp;0.049)\u003csup\u003e45\u003c/sup\u003e. This difference may arise from mechanical compression of tumors by SEMS, which can lead to the spread of tumor cells into the bloodstream\u003csup\u003e\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e. Studies have shown an increase in circulating tumor cells and cytokeratin-20 mRNA expression in patients after SEMS placement, suggesting it may facilitate tumor dissemination\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Additionally, SEMS placement is associated with higher rates of perineural and vascular invasion, which are risk factors for metastasis and recurrence\u003csup\u003e\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e. However, neoadjuvant chemotherapy has been shown to reduce these invasions\u003csup\u003e\u003cspan additionalcitationids=\"CR48 CR49\" citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u003c/sup\u003e. Our research indicates that combining SEMS with neoadjuvant chemotherapy significantly decreases 5-year rates of distant metastasis and local recurrence, potentially improving patient outcomes by eliminating tumor cells and controlling tumor spread.\u003c/p\u003e \u003cp\u003eSome meta-analyses have shown no significant difference in long-term survival between the SEMS-bridging and emergency surgery groups \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. However, other studies have reported varying results. Some researchers found that the 5-year OS rate was lower in the SEMS group compared to the emergency surgery group (30% vs. 67%, P\u0026thinsp;=\u0026thinsp;0.001)\u003csup\u003e51\u003c/sup\u003e. Neoadjuvant chemotherapy has been demonstrated to significantly improve prognosis in colorectal cancer patients by inducing tumor regression while maintaining a high safety profile\u003csup\u003e\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e\u003c/sup\u003e. Our center proposed a strategy combining SEMS placement with neoadjuvant chemotherapy and found it effective in the short term\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. A retrospective analysis of clinical data from patients who underwent emergency surgery and SEMS-neoadjuvant-surgery indicated that the 1-year DFS rate in the SEMS-neoadjuvant-surgery group was slightly higher than in the emergency surgery group. However, this difference was insignificant (96.8% vs. 91.3%, P\u0026thinsp;=\u0026thinsp;0.562)\u003csup\u003e27\u003c/sup\u003e. This may be attributed to the small sample size and short follow-up duration. Our study's long-term follow-up results indicated that patients in the SEMS-neoadjuvant-surgery group experienced significantly better OS and DFS in 5 years compared to those in the SEMS-only group. Furthermore, the SEMS-surgery strategy emerged as an independent risk factor influencing the survival prognosis of patients with obstructive left-sided colon cancer. These findings suggest that the SEMS-neoadjuvant-surgery strategy may enhance the long-term prognosis for patients with this condition.\u003c/p\u003e \u003cp\u003eThis study has some limitations. Firstly, it is a single-center, retrospective case-control study, which means the sample size was relatively small. Additionally, the study did not include a group for emergency surgeries, limiting our ability to make a three-way comparison. We anticipate future large-sample, prospective, multicenter clinical studies that will provide a more accurate assessment of the incidence of complications related to SEMS-neoadjuvant-surgery and long-term survival outcomes.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study shows that the strategy of SEMS-neoadjuvant-surgery significantly enhances surgical outcomes and long-term prognosis for patients with obstructive left-sided colon cancer, compared to the SEMS-surgery strategy. Significantly, this combined approach does not increase the risk of complications related to the SEMS. These findings suggest promising clinical applications and preliminarily confirm this approach's safety, effectiveness, and long-term benefits. However, it is essential to continue monitoring and managing patients who undergo SEMS placement in clinical practice.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eself-expanding metallic stent\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eSEMS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eoverall survival\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eOS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003edisease-free survival\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eDFS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: Multidisciplinary Clinical Research Innovation Team Project of Beijing Chaoyang Hospital (CYDXK202206); National Natural Science Foundation of China (82070685).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Declarations: \u003c/strong\u003eThis study was approved by the Ethics Committee of Beijing Chaoyang Hospital, Capital Medical University (Approval No: 2016-Ke-161-1). All procedures involving human participants were in accordance with the ethical standards of the 1964 Helsinki declaration and its later amendments. Written informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u003c/strong\u003e The authors of the article do not have commercial associations (e.g., consultancies, stock ownership, equity interests, patent-licensing arrangements) that might pose a conflict of interest in connection with the submitted article. There are no conflicts of interest associated with any of the senior authors or other coauthors who contributed their efforts to the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions:\u003c/strong\u003e Y.S and Z.W.Z wrote the main manuscript; J.G.H and K.C revise the manuscript; C.X.Y, Y.S.L, G.H.W and H.Q collect data; J.G.H and Z.J.W design the work. All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u003c/strong\u003e All data generated or analyzed during this study are included in this published article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDekker E, Tanis PJ, Vleugels JLA, Kasi PM, Wallace MB. Colorectal cancer. \u003cem\u003eLancet\u003c/em\u003e. 2019;394(10207):1467-1480. doi:10.1016/S0140-6736(19)32319-0\u003c/li\u003e\n\u003cli\u003eFabregas JC, Ramnaraign B, George TJ. Clinical Updates for Colon Cancer Care in 2022. Clin Colorectal Cancer. 2022;21(3):198-203. doi:10.1016/j.clcc.2022.05.006\u003c/li\u003e\n\u003cli\u003eVeld JV, Amelung FJ, Borstlap WAA, et al. Changes in Management of Left-Sided Obstructive Colon Cancer: National Practice and Guideline Implementation. \u003cem\u003eJ Natl Compr Canc Netw\u003c/em\u003e. 2019;17(12):1512-1520. doi:10.6004/jnccn.2019.7326\u003c/li\u003e\n\u003cli\u003eYuichiro Y, Shigenobu E, Hiroaki N, et al. Laparoscopic resection after self-expanding stent insertion for obstructive left-sided colorectal cancer: Clinicopathological features and outcomes. \u003cem\u003eScand J Surg\u003c/em\u003e 2022;111(2) doi: 10.1177/14574969221096191\u003c/li\u003e\n\u003cli\u003eYokoyama Y, Emoto S, Nozawa H, et al. Laparoscopic resection after self-expanding stent insertion for obstructive left-sided colorectal cancer: Clinicopathological features and outcomes. \u003cem\u003eScand J Surg\u003c/em\u003e. 2022;111(2):14574969221096191. doi:10.1177/14574969221096191\u003c/li\u003e\n\u003cli\u003eJain SR, Yaow CYL, Ng CH, et al. Comparison of colonic stents, stomas and resection for obstructive left colon cancer: a meta-analysis. \u003cem\u003eTech Coloproctol\u003c/em\u003e. 2020;24(11):1121-1136. doi:10.1007/s10151-020-02296-5\u003c/li\u003e\n\u003cli\u003eHan JG, Wang ZJ, Zeng WG, et al. Efficacy and safety of self-expanding metallic stent placement followed by neoadjuvant chemotherapy and scheduled surgery for treatment of obstructing left-sided colonic cancer. \u003cem\u003eBMC Cancer\u003c/em\u003e. 2020;20(1):57. Published 2020 Jan 28. doi:10.1186/s12885-020-6560-x\u003c/li\u003e\n\u003cli\u003eHuang X, Lv B, Zhang S, Meng L. Preoperative colonic stents versus emergency surgery for acute left-sided malignant colonic obstruction: a meta-analysis. \u003cem\u003eJ Gastrointest Surg\u003c/em\u003e. 2014;18(3):584-591. doi:10.1007/s11605-013-2344-9\u003c/li\u003e\n\u003cli\u003eSpannenburg L, Sanchez Gonzalez M, Brooks A, et al. Surgical outcomes of colonic stents as a bridge to surgery versus emergency surgery for malignant colorectal obstruction: A systematic review and meta-analysis of high quality prospective and randomised controlled trials. \u003cem\u003eEur J Surg Oncol\u003c/em\u003e. 2020;46(8):1404-1414. doi:10.1016/j.ejso.2020.04.052\u003c/li\u003e\n\u003cli\u003eSato R, Oikawa M, Kakita T, et al. Comparison of the long-term outcomes of the self-expandable metallic stent and transanal decompression tube for obstructive colorectal cancer. \u003cem\u003eAnn Gastroenterol Surg\u003c/em\u003e. 2019;3(2):209-216. Published 2019 Jan 29. doi:10.1002/ags3.12235\u003c/li\u003e\n\u003cli\u003eGorissen KJ, Tuynman JB, Fryer E, et al. Local recurrence after stenting for obstructing left-sided colonic cancer. \u003cem\u003eBr J Surg\u003c/em\u003e. 2013;100(13):1805-1809. doi:10.1002/bjs.9297\u003c/li\u003e\n\u003cli\u003eMaruthachalam K, Lash GE, Shenton BK, Horgan AF. Tumour cell dissemination following endoscopic stent insertion. \u003cem\u003eBr J Surg\u003c/em\u003e. 2007;94(9):1151-1154. doi:10.1002/bjs.5790\u003c/li\u003e\n\u003cli\u003eCao K, Wang ZJ, Han JG. [Treatment of obstructive colorectal cancer]. Zhonghua Wei Chang Wai Ke Za Zhi. 2023 Jan 25;26(1):44-50. Chinese. doi: 10.3760/cma.j.cn441530-20221114-00465. PMID: 36649999.\u003c/li\u003e\n\u003cli\u003eBenson AB, Venook AP, Al-Hawary MM, Arain MA, Chen YJ, Ciombor KK, Cohen S, Cooper HS, Deming D, Farkas L, Garrido-Laguna I, Grem JL, Gunn A, Hecht JR, Hoffe S, Hubbard J, Hunt S, Johung KL, Kirilcuk N, Krishnamurthi S, Messersmith WA, Meyerhardt J, Miller ED, Mulcahy MF, Nurkin S, Overman MJ, Parikh A, Patel H, Pedersen K, Saltz L, Schneider C, Shibata D, Skibber JM, Sofocleous CT, Stoffel EM, Stotsky-Himelfarb E, Willett CG, Gregory KM, Gurski LA. Colon Cancer, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2021 Mar 2;19(3):329-359. doi: 10.6004/jnccn.2021.0012. PMID: 33724754\u003c/li\u003e\n\u003cli\u003eDindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004 Aug;240(2):205-13. doi: 10.1097/01.sla.0000133083.54934.ae. PMID: 15273542; PMCID: PMC1360123.\u003c/li\u003e\n\u003cli\u003eTejero E, Mainar A, Fern\u0026aacute;ndez L, Tob\u0026iacute;o R, De Gregorio MA. New procedure for the treatment of colorectal neoplastic obstructions. Dis Colon Rectum. 1994 Nov;37(11):1158-9. doi: 10.1007/BF02049822. PMID: 7956588.\u003c/li\u003e\n\u003cli\u003ePark SJ, Lee KY, Kwon SH, Lee SH. Stenting as a Bridge to Surgery for Obstructive Colon Cancer: Does It Have Surgical Merit or Oncologic Demerit? Ann Surg Oncol. 2016 Mar;23(3):842-8. doi: 10.1245/s10434-015-4897-1. Epub 2015 Dec 14. PMID: 26668086.\u003c/li\u003e\n\u003cli\u003eVeld JV, Amelung FJ, Borstlap WAA, Eise van Halsema E, Consten ECJ, Siersema PD, Ter Borg F, Silvester van der Zaag E, Fockens P, Bemelman WA, Elise van Hooft J, Tanis PJ; Dutch Snapshot Research Group. Changes in Management of Left-Sided Obstructive Colon Cancer: National Practice and Guideline Implementation. J Natl Compr Canc Netw. 2019 Dec;17(12):1512-1520. doi: 10.6004/jnccn.2019.7326. PMID: 31805533.\u003c/li\u003e\n\u003cli\u003eVogel JD, Eskicioglu C, Weiser MR, Feingold DL, Steele SR. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Treatment of Colon Cancer. Dis Colon Rectum. 2017 Oct;60(10):999-1017. doi: 10.1097/DCR.0000000000000926. PMID: 28891842.\u003c/li\u003e\n\u003cli\u003eAnsaloni L, Andersson RE, Bazzoli F, Catena F, Cennamo V, Di Saverio S, Fuccio L, Jeekel H, Lepp\u0026auml;niemi A, Moore E, Pinna AD, Pisano M, Repici A, Sugarbaker PH, Tuech JJ. Guidelenines in the management of obstructing cancer of the left colon: consensus conference of the world society of emergency surgery (WSES) and peritoneum and surgery (PnS) society. World J Emerg Surg. 2010 Dec 28;5:29. doi: 10.1186/1749-7922-5-29. PMID: 21189148; PMCID: PMC3022691.\u003c/li\u003e\n\u003cli\u003evan Hooft JE, Veld JV, Arnold D, Beets-Tan RGH, Everett S, G\u0026ouml;tz M, van Halsema EE, Hill J, Manes G, Meisner S, Rodrigues-Pinto E, Sabbagh C, Vandervoort J, Tanis PJ, Vanbiervliet G, Arezzo A. Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2020. Endoscopy. 2020 May;52(5):389-407. doi: 10.1055/a-1140-3017. Epub 2020 Apr 7. PMID: 32259849.\u003c/li\u003e\n\u003cli\u003eAlenezi A, McGrath I, Kimpton A, Livesay K. Quality of life among ostomy patients: A narrative literature review. J Clin Nurs. 2021 Nov;30(21-22):3111-3123. doi: 10.1111/jocn.15840. Epub 2021 May 12. PMID: 33982291.\u003c/li\u003e\n\u003cli\u003eAoyama T, Oba K, Honda M, Muto M, Mayanagi S, Maeda H, Kanda M, Kashiwabara K, Sakamoto J, Yoshikawa T. The clinical impacts of postoperative complications after colon cancer surgery for the clinical course of adjuvant treatment and survival. Int J Clin Oncol. 2023 Jun;28(6):777-784. doi: 10.1007/s10147-023-02332-y. Epub 2023 Apr 11. PMID: 37039949; PMCID: PMC10232630.\u003c/li\u003e\n\u003cli\u003e\u0026Ouml;ist\u0026auml;m\u0026ouml; E, Hjern F, Blomqvist L, Falk\u0026eacute;n Y, Pekkari K, Abraham-Nordling M. Emergency management with resection versus proximal stoma or stent treatment and planned resection in malignant left-sided colon obstruction. World J Surg Oncol. 2016 Aug 30;14(1):232. doi: 10.1186/s12957-016-0994-2. PMID: 27577887; PMCID: PMC5006427.\u003c/li\u003e\n\u003cli\u003eHohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation--technical notes and outcome. Colorectal Dis. 2009 May;11(4):354-64; discussion 364-5. doi: 10.1111/j.1463-1318.2008.01735.x. Epub 2009 Nov 5. PMID: 19016817.\u003c/li\u003e\n\u003cli\u003eMabardy A, Miller P, Goldstein R, Coury J, Hackford A, Dao H. Stenting for obstructing colon cancer: fewer complications and colostomies. JSLS. 2015 Jan-Mar;19(1):e2014.00254. doi: 10.4293/JSLS.2014.00254. PMID: 25848200; PMCID: PMC4379870.\u003c/li\u003e\n\u003cli\u003eZhang J, Deng J, Hu J, Zhong Q, Li J, Su M, Liu W, Lv M, Xu T, Lin D, Guo X. Safety and feasibility of neoadjuvant chemotherapy as a surgical bridge for acute left-sided malignant colorectal obstruction: a retrospective study. BMC Cancer. 2022 Jul 21;22(1):806. doi: 10.1186/s12885-022-09906-5. PMID: 35864459; PMCID: PMC9306149.\u003c/li\u003e\n\u003cli\u003eVeld JV, Amelung FJ, Borstlap WAA, van Halsema EE, Consten ECJ, Siersema PD, Ter Borg F, van der Zaag ES, de Wilt JHW, Fockens P, Bemelman WA, van Hooft JE, Tanis PJ; Dutch Snapshot Research Group. Comparison of Decompressing Stoma vs Stent as a Bridge to Surgery for Left-Sided Obstructive Colon Cancer. JAMA Surg. 2020 Mar 1;155(3):206-215. doi: 10.1001/jamasurg.2019.5466. Erratum in: JAMA Surg. 2020 Mar 1;155(3):269. doi: 10.1001/jamasurg.2020.0131. PMID: 31913422; PMCID: PMC6990965.\u003c/li\u003e\n\u003cli\u003eHong SP, Kim TI. Colorectal stenting: an advanced approach to malignant colorectal obstruction. World J Gastroenterol. 2014 Nov 21;20(43):16020-8. doi: 10.3748/wjg.v20.i43.16020. PMID: 25473154; PMCID: PMC4239488.\u003c/li\u003e\n\u003cli\u003evan Hooft JE, Bemelman WA, Oldenburg B, Marinelli AW, Lutke Holzik MF, Grubben MJ, Sprangers MA, Dijkgraaf MG, Fockens P; collaborative Dutch Stent-In study group. Colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a multicentre randomised trial. Lancet Oncol. 2011 Apr;12(4):344-52. doi: 10.1016/S1470-2045(11)70035-3. Erratum in: Lancet Oncol. 2011 May;12(5):418. PMID: 21398178.\u003c/li\u003e\n\u003cli\u003eKong JC, Lee J, Gosavi R, Ngan SY, Tillman MM, Bednarski BK, Heriot AG, Chang GJ, Warrier SK. Is neoadjuvant therapy an alternative strategy to immediate surgery in locally perforated colon cancer? Colorectal Dis. 2021 Dec;23(12):3162-3172. doi: 10.1111/codi.15868. Epub 2021 Aug 28. PMID: 34379861.\u003c/li\u003e\n\u003cli\u003eLow DE, Panto PN, Hastings AG, Nigam K. An unusual complication of a colonic wallstent. Cardiovasc Intervent Radiol. 2004 Jul-Aug;27(4):377-8. doi: 10.1007/s00270-004-0195-1. Epub 2004 Jun 16. PMID: 15346212.\u003c/li\u003e\n\u003cli\u003eMauro A, Scalvini D, Borgetto S, Fugazzola P, Mazza S, Perretti I, Gallotti A, Pagani A, Ansaloni L, Anderloni A. Malignant Acute Colonic Obstruction: Multidisciplinary Approach for Endoscopic Management. Cancers (Basel). 2024 Feb 18;16(4):821. doi: 10.3390/cancers16040821. PMID: 38398212; PMCID: PMC10887189.\u003c/li\u003e\n\u003cli\u003eTanaka A, Sadahiro S, Yasuda M, Shimizu S, Maeda Y, Suzuki T, Tokunaga N, Ogoshi K. Endoscopic balloon dilation for obstructive colorectal cancer: a basic study on morphologic and pathologic features associated with perforation. Gastrointest Endosc. 2010 Apr;71(4):799-805. doi: 10.1016/j.gie.2009.10.059. PMID: 20363422.\u003c/li\u003e\n\u003cli\u003eDatye A, Hersh J. Colonic perforation after stent placement for malignant colorectal obstruction--causes and contributing factors. Minim Invasive Ther Allied Technol. 2011 May;20(3):133-40. doi: 10.3109/13645706.2010.518787. Epub 2010 Oct 8. PMID: 20929424.\u003c/li\u003e\n\u003cli\u003eMauro A, Scalvini D, Borgetto S, Fugazzola P, Mazza S, Perretti I, Gallotti A, Pagani A, Ansaloni L, Anderloni A. Malignant Acute Colonic Obstruction: Multidisciplinary Approach for Endoscopic Management. Cancers (Basel). 2024 Feb 18;16(4):821. doi: 10.3390/cancers16040821. PMID: 38398212; PMCID: PMC10887189.\u003c/li\u003e\n\u003cli\u003eCennamo V, Fuccio L, Mutri V, Minardi ME, Eusebi LH, Ceroni L, Laterza L, Ansaloni L, Pinna AD, Salfi N, Martoni AA, Bazzoli F. Does stent placement for advanced colon cancer increase the risk of perforation during bevacizumab-based therapy? Clin Gastroenterol Hepatol. 2009 Nov;7(11):1174-6. doi: 10.1016/j.cgh.2009.07.015. Epub 2009 Jul 22. PMID: 19631290.\u003c/li\u003e\n\u003cli\u003eFuccio L, Correale L, Arezzo A, Repici A, Manes G, Trovato C, Mangiavillano B, Manno M, Cortelezzi CC, Dinelli M, Cennamo V, de Bellis M; KRASTENT Study Group. Influence of K-ras status and anti-tumour treatments on complications due to colorectal self-expandable metallic stents: a retrospective multicentre study. Dig Liver Dis. 2014 Jun;46(6):561-7. doi: 10.1016/j.dld.2014.02.006. Epub 2014 Mar 14. PMID: 24630948. \u003c/li\u003e\n\u003cli\u003eSebastian S, Johnston S, Geoghegan T, Torreggiani W, Buckley M. Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol. 2004 Oct;99(10):2051-7. doi: 10.1111/j.1572-0241.2004.40017.x. PMID: 15447772.\u003c/li\u003e\n\u003cli\u003eLee KM, Shin SJ, Hwang JC, Cheong JY, Yoo BM, Lee KJ, Hahm KB, Kim JH, Cho SW. Comparison of uncovered stent with covered stent for treatment of malignant colorectal obstruction. Gastrointest Endosc. 2007 Nov;66(5):931-6. doi: 10.1016/j.gie.2007.02.064. Epub 2007 Sep 4. PMID: 17767930.\u003c/li\u003e\n\u003cli\u003eHan SH, Lee JH. Colonic stent-related complications and their management. Clin Endosc. 2014 Sep;47(5):415-9. doi: 10.5946/ce.2014.47.5.415. Epub 2014 Sep 30. PMID: 25325000; PMCID: PMC4198557.\u003c/li\u003e\n\u003cli\u003eDharmadhikari R, Nice C. Complications of colonic stenting: a pictorial review. Abdom Imaging. 2008 May-Jun;33(3):278-84. doi: 10.1007/s00261-007-9240-2. PMID: 17505852.\u003c/li\u003e\n\u003cli\u003ePark S, Cheon JH, Park JJ, Moon CM, Hong SP, Lee SK, Kim TI, Kim WH. Comparison of efficacies between stents for malignant colorectal obstruction: a randomized, prospective study. Gastrointest Endosc. 2010 Aug;72(2):304-10. doi: 10.1016/j.gie.2010.02.046. Epub 2010 Jun 19. PMID: 20561619.\u003c/li\u003e\n\u003cli\u003eLee JS, Lee HS, Kim ES, Jung MK, Jung JT, Kim HG, Lee DW, Kim DJ, Lee YJ, Yang CH; Daegu-Gyeongbuk Gastrointestinal Study Group (DGSG). Comparison of different types of covered self-expandable metal stents for malignant colorectal obstruction. Surg Endosc. 2021 Aug;35(8):4124-4133. doi: 10.1007/s00464-020-07869-x. Epub 2020 Aug 13. PMID: 32789723.\u003c/li\u003e\n\u003cli\u003eFoo CC, Poon SHT, Chiu RHY, Lam WY, Cheung LC, Law WL. Is bridge to surgery stenting a safe alternative to emergency surgery in malignant colonic obstruction: a meta-analysis of randomized control trials. Surg Endosc. 2019 Jan;33(1):293-302. doi: 10.1007/s00464-018-6487-3. Epub 2018 Oct 19. PMID: 30341649.\u003c/li\u003e\n\u003cli\u003eYamashita S, Tanemura M, Sawada G, Moon J, Shimizu Y, Yamaguchi T, Kuwai T, Urata Y, Kuraoka K, Hatanaka N, Yamashita Y, Taniyama K. Impact of endoscopic stent insertion on detection of viable circulating tumor cells from obstructive colorectal cancer. Oncol Lett. 2018 Jan;15(1):400-406. doi: 10.3892/ol.2017.7339. Epub 2017 Nov 2. PMID: 29391884; PMCID: PMC5769419.\u003c/li\u003e\n\u003cli\u003eAlotaibi AM, Lee JL, Kim J, Lim SB, Yu CS, Kim TW, Kim JH, Kim JC. Prognostic and Oncologic Significance of Perineural Invasion in Sporadic Colorectal Cancer. Ann Surg Oncol. 2017 Jun;24(6):1626-1634. doi: 10.1245/s10434-016-5748-4. Epub 2017 Jan 9. PMID: 28070726.\u003c/li\u003e\n\u003cli\u003eBenson AB 3rd, Venook AP, Cederquist L, Chan E, Chen YJ, Cooper HS, Deming D, Engstrom PF, Enzinger PC, Fichera A, Grem JL, Grothey A, Hochster HS, Hoffe S, Hunt S, Kamel A, Kirilcuk N, Krishnamurthi S, Messersmith WA, Mulcahy MF, Murphy JD, Nurkin S, Saltz L, Sharma S, Shibata D, Skibber JM, Sofocleous CT, Stoffel EM, Stotsky-Himelfarb E, Willett CG, Wu CS, Gregory KM, Freedman-Cass D. Colon Cancer, Version 1.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2017 Mar;15(3):370-398. doi: 10.6004/jnccn.2017.0036. PMID: 28275037.\u003c/li\u003e\n\u003cli\u003eHu Y, Fan J, Xv Y, Hu Y, Ding Y, Jiang Z, Tao Q. Comparison of safety between self-expanding metal stents as a bridge to surgery and emergency surgery based on pathology: a meta-analysis. BMC Surg. 2020 Oct 27;20(1):255. doi: 10.1186/s12893-020-00908-3. PMID: 33109142; PMCID: PMC7592574\u003c/li\u003e\n\u003cli\u003eBalciscueta I, Balciscueta Z, Uribe N, Garc\u0026iacute;a-Granero E. Perineural invasion is increased in patients receiving colonic stenting as a bridge to surgery: a systematic review and meta-analysis. Tech Coloproctol. 2021 Feb;25(2):167-176. doi: 10.1007/s10151-020-02350-2. Epub 2020 Nov 17. PMID: 33200308.\u003c/li\u003e\n\u003cli\u003eCharles S, Fran\u0026ccedil;ois B, Momar D, et al. Is stenting as \u0026quot;a bridge to surgery\u0026quot; an oncologically safe strategy for the management of acute, left-sided, malignant, colonic obstruction? A comparative study with a propensity score analysis. \u003cem\u003eAnn Surg\u003c/em\u003e 2013;258(1) doi: 10.1097/SLA.0b013e31827e30ce\u003c/li\u003e\n\u003cli\u003eMorton D, Seymour M, Magill L, Handley K, Glasbey J, Glimelius B, Palmer A, Seligmann J, Laurberg S, Murakami K, West N, Quirke P, Gray R; FOxTROT Collaborative Group. Preoperative Chemotherapy for Operable Colon Cancer: Mature Results of an International Randomized Controlled Trial. J Clin Oncol. 2023 Mar 10;41(8):1541-1552. doi: 10.1200/JCO.22.00046. Epub 2023 Jan 19. PMID: 36657089; PMCID: PMC10022855.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"self-expanding metallic stents, neoadjuvant chemotherapy, completely obstructive left-sided colon cancer, complications, long-term efficacy","lastPublishedDoi":"10.21203/rs.3.rs-6830907/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6830907/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eTo 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.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA 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.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eAll 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.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe 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.\u003c/p\u003e","manuscriptTitle":"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","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-01 09:01:49","doi":"10.21203/rs.3.rs-6830907/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3b0d30bc-12f0-45cf-82d8-c1d666cc2df5","owner":[],"postedDate":"July 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-28T10:03:19+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-01 09:01:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6830907","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6830907","identity":"rs-6830907","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}