Neoadjuvant chemotherapy as a bridge to surgery versus direct surgery following SEMS placement in obstructive left-sided colon cancer: a multicenter prospective cohort study.

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 (COLCC).

Methods: A multicenter prospective study enrolled 246 COLCC patients, comparing SEMS-surgery (n = 105) and SEMS-neoadjuvant-surgery (n = 141). 1:1 propensity score matching (PSM) and 8-week landmark analyses were used to mitigate biases. Primary outcomes included SEMS-related complications, overall survival (OS), and disease-free survival (DFS).

Results: In the PSM cohort (n = 206), SEMS-related complication rates were similar between the neoadjuvant and surgery-alone groups (15.5% vs. 14.6%, P = 0.845). The SEMS-neoadjuvant-surgery group demonstrated superior 5-year OS (66.2% vs. 51.7%, P < 0.001) and 5-year DFS (65.3% vs. 40.0%, P < 0.001). Landmark analysis consistently validated these survival benefits. Multivariable Cox regression confirmed neoadjuvant chemotherapy as an independent protective factor for both OS (HR = 0.436, 95% CI: 0.188-0.996, P = 0.015) and DFS (HR = 0.661, 95% CI: 0.551-0.830, P = 0.002).

Conclusion: The SEMS-neoadjuvant-surgery strategy is associated with superior long-term survival without increasing SEMS-related complications, strongly supporting its clinical feasibility and oncological safety for COLCC.