Determining the difference in the efficacy and safety of self-expandable metallic stents as a bridge to surgery for obstructive colon cancer among patients in the CROSS 0 group and those in the CROSS 1 or 2 group: a pooled analysis of data from two Japanese prospective multicenter trials

Surg Today. 2020 Sep;50(9):984-994. doi: 10.1007/s00595-020-01970-3. Epub 2020 Feb 6.


Purpose: This study compared the feasibility and safety of endoscopic placement of self-expandable metallic stents (SEMSs) as a bridge to surgery (BTS) between patients with obstructive colorectal cancer (CRC) classified as ColoRectal Obstruction Scoring System (CROSS) 0 and those with CROSS 1 or 2.

Methods: We conducted a post hoc analysis of two prospective, observational, single-arm multicenter clinical trials and performed a pooled analysis of the data. In total, 336 consecutive patients with malignant colorectal obstruction underwent SEMS placement. The primary endpoint was clinical success, defined as resolution of symptoms and radiological findings within 24 h. Secondary endpoints were technical success and adverse events.

Results: High clinical (98.0% vs. 98.4%) and technical (96.7% vs. 97.8%) success rates were observed in both groups (CROSS 0 vs. CROSS 1 or 2). The adverse event rate was low. The mean stricture length was lower (3.8 ± 1.2 cm vs. 4.4 ± 1.8 cm) and laparoscopic surgery more common (56.7% vs 52.2%) in the CROSS 0 group than in the CROSS 1 and 2 group.

Conclusion: This study was the first to compare the degree of stricture in different CROSS groups and demonstrated comparable results with respect to the short-term efficacy and safety of SEMS placement as a BTS for obstructive CRC in CROSS 0, 1, and 2 patients.

Keywords: Bridge to surgery; Colorectal cancer; Colorectal obstruction; Pooled analysis; Self-expandable metallic stents.

MeSH terms

  • Colonic Neoplasms / complications
  • Colonic Neoplasms / surgery*
  • Data Analysis*
  • Endoscopy, Gastrointestinal / methods*
  • Feasibility Studies
  • Humans
  • Intestinal Obstruction / etiology
  • Intestinal Obstruction / surgery*
  • Laparoscopy / methods*
  • Safety
  • Self Expandable Metallic Stents* / adverse effects
  • Severity of Illness Index
  • Treatment Outcome