Research progress on safety of self-expanding metal stent as a bridge to surgery in obstructive colorectal cancer_West China Medical Journal

Authors：

HU Yang ^1,2 , TAO Qingsong ^1,2 ,  JI Zhenling ^1,2

1. School of Clinical Medicine, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, P. R. China;
2. Department of General Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing, Jiangsu 210009, P. R. China;

Corresponding author：

JI Zhenling, Email: correspond2020@163.com

Keywords：

Self-expanding metal stent; bridge to surgery; colorectal cancer; acute intestinal obstruction

DOI：

10.7507/1002-0179.202105005

Video：

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Abstract Full text Figures/Tables Video References Cited by

The complication rate and mortality rate of traditional emergency surgery for acute obstructive colorectal cancer are very high. Self-expanding metal stent (SEMS) as a bridge to surgery can rapidly decompress the intestinal tract and radical surgery can be performed after the patients’ general condition improve. This technology has been widely developed, but its safety is still controversial, mainly related to the risk of SEMS implantation and its impact on the long-term survival of patients. This article will introduce the rationale, pathophysiology, short-term safety and long-term oncology safety of SEMS implantation, in order to provide basis for clinicians to choose treatment methods.

Citation： HU Yang, TAO Qingsong, JI Zhenling. Research progress on safety of self-expanding metal stent as a bridge to surgery in obstructive colorectal cancer. West China Medical Journal, 2022, 37(11): 1735-1741. doi: 10.7507/1002-0179.202105005 Copy

1.	吴春晓, 顾凯, 龚杨明, 等. 2015 年中国结直肠癌发病和死亡情况分析. 中国癌症杂志, 2020, 30(4): 241-245.
2.	Baer C, Menon R, Bastawrous S, et al. Emergency presentations of colorectal cancer. Surg Clin North Am, 2017, 97(3): 529-545.
3.	Pisano M, Zorcolo L, Merli C, et al. 2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation. World J Emerg Surg, 2018, 13: 36.
4.	Cappell MS, Batke M. Mechanical obstruction of the small bowel and colon. Med Clin North Am, 2008, 92(3): 575-597, viii.
5.	Smith DA, Kashyap S, Nehring SM. Bowel obstruction//StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2022: 5.
6.	Ormando VM, Palma R, Fugazza A, et al. Colonic stents for malignant bowel obstruction: current status and future prospects. Expert Rev Med Devices, 2019, 16(12): 1053-1061.
7.	Sasaki T, Ishibashi R, Yoshida S, et al. Comparing the mechanical properties of a self-expandable metallic stent for colorectal obstruction: proposed measurement method of axial force using a new measurement machine. Dig Endosc, 2021, 33(1): 170-178.
8.	Bethge N, Sommer A, Gross U, et al. Human tissue responses to metal stents implanted in vivo for the palliation of malignant stenoses. Gastrointest Endosc, 1996, 43(6): 596-602.
9.	Vakil N. Expandable metal stents: principles and tissue responses. Gastrointest Endosc Clin N Am, 2011, 21(3): 351-357, vii.
10.	Fryer E, Gorissen KJ, Wang LM, et al. Spectrum of histopathological changes encountered in stented colorectal carcinomas. Histopathology, 2015, 66(4): 480-484.
11.	Amini N, Haydel D, Reisian N, et al. Colorectal stents orient specimens and induce artifacts that mimic Crohn disease. Int J Surg Pathol, 2012, 20(2): 161-168.
12.	Cheung DY, Lee YK, Yang CH. Status and literature review of self-expandable metallic stents for malignant colorectal obstruction. Clin Endosc, 2014, 47(1): 65-73.
13.	Datye A, Hersh J. Colonic perforation after stent placement for malignant colorectal obstruction-causes and contributing factors. Minim Invasive Ther Allied Technol, 2011, 20(3): 133-140.
14.	Small AJ, Coelho-Prabhu N, Baron TH. Endoscopic placement of self-expandable metal stents for malignant colonic obstruction: long-term outcomes and complication factors. Gastrointest Endosc, 2010, 71(3): 560-572.
15.	Lee JM, Byeon JS. Colorectal stents: current status. Clin Endosc, 2015, 48(3): 194-200.
16.	Choi JH, Lee YJ, Kim ES, et al. Covered self-expandable metal stents are more associated with complications in the management of malignant colorectal obstruction. Surg Endosc, 2013, 27(9): 3220-3227.
17.	Sebastian S, Johnston S, Geoghegan T, et al. Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol, 2004, 99(10): 2051-2057.
18.	van Hooft JE, van Halsema EE, Vanbiervliet G, et al. Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Gastrointest Endosc, 2014, 80(5): 747-775.
19.	Kim SJ, Kim HW, Park SB, et al. Colonic perforation either during or after stent insertion as a bridge to surgery for malignant colorectal obstruction increases the risk of peritoneal seeding. Surg Endosc, 2015, 29(12): 3499-3506.
20.	Zanghì A, Piccolo G, Cavallaro A, et al. A pilot study about the oncologic safety of colonic self-expandable metal stents (SEMS) in obstructive colon cancer: is occlusion always better than “silent” perforation?. Eur Rev Med Pharmacol Sci, 2016, 20(24): 5242-5248.
21.	Sloothaak DA, van den Berg MW, Dijkgraaf MG, et al. Oncological outcome of malignant colonic obstruction in the Dutch Stent-In 2 trial. Br J Surg, 2014, 101(13): 1751-1757.
22.	Chan DKH, Tan KK. Stenting versus surgery in obstructed malignant colorectal cancer-a review of short and long-term results. J Gastrointest Oncol, 2020, 11(3): 486-490.
23.	Costa Santos MP, Palmela C, Ferreira R, et al. Self-expandable metal stents for colorectal cancer: from guidelines to clinical practice. GE Port J Gastroenterol, 2016, 23(6): 293-299.
24.	Cao Y, Deng S, Wu K, et al. Oncological consequence of emergent resection of perforated colon cancer with complete obstruction after stent insertion as a bridge to surgery. Int J Colorectal Dis, 2019, 34(3): 545-547.
25.	Cennamo V, Fuccio L, Mutri V, et al. Does stent placement for advanced colon cancer increase the risk of perforation during bevacizumab-based therapy?. Clin Gastroenterol Hepatol, 2009, 7(11): 1174-1176.
26.	Imbulgoda A, MacLean A, Heine J, et al. Colonic perforation with intraluminal stents and bevacizumab in advanced colorectal cancer: retrospective case series and literature review. Can J Surg, 2015, 58(3): 167-171.
27.	Matsuda A, Yamada T, Matsumoto S, et al. Systemic chemotherapy is a promising treatment option for patients with colonic stents: a review. J Anus Rectum Colon, 2021, 5(1): 1-10.
28.	Pacheco-Barcia V, Mondéjar R, Martínez-Sáez O, et al. Safety and oncological outcomes of bevacizumab therapy in patients with advanced colorectal cancer and self-expandable metal stents. Clin Colorectal Cancer, 2019, 18(3): e287-e293.
29.	Tanaka I, Hisai H, Miyazaki E, et al. A case of delayed colonic perforation after metallic stent placement for advanced descending colon cancer during bevacizumab-based chemotherapy. Gan To Kagaku Ryoho, 2011, 38(12): 2319-2321.
30.	Maruthachalam K, Lash GE, Shenton BK, et al. Tumour cell dissemination following endoscopic stent insertion. Br J Surg, 2007, 94(9): 1151-1154.
31.	Takahashi G, Yamada T, Iwai T, et al. Oncological assessment of stent placement for obstructive colorectal cancer from circulating cell-free DNA and circulating tumor DNA dynamics. Ann Surg Oncol, 2018, 25(3): 737-744.
32.	Ishibashi R, Yoshida S, Odawara N, et al. Detection of circulating colorectal cancer cells by a custom microfluid system before and after endoscopic metallic stent placement. Oncol Lett, 2019, 18(6): 6397-6404.
33.	Yamashita S, Tanemura M, Sawada G, et al. Impact of endoscopic stent insertion on detection of viable circulating tumor cells from obstructive colorectal cancer. Oncol Lett, 2018, 15(1): 400-406.
34.	Joyce JA, Pollard JW. Microenvironmental regulation of metastasis. Nat Rev Cancer, 2009, 9(4): 239-252.
35.	Chen XQ, Xue CR, Hou P, et al. Lymphocyte-to-monocyte ratio effectively predicts survival outcome of patients with obstructive colorectal cancer. World J Gastroenterol, 2019, 25(33): 4970-4984.
36.	Haraguchi N, Ikeda M, Miyake M, et al. Colonic stenting as a bridge to surgery for obstructive colorectal cancer: advantages and disadvantages. Surg Today, 2016, 46(11): 1310-1317.
37.	Kang SI, Oh HK, Yoo JS, et al. Oncologic outcomes of preoperative stent insertion first versus immediate surgery for obstructing left-sided colorectal cancer. Surg Oncol, 2018, 27(2): 216-224.
38.	Kim HJ, Choi GS, Park JS, et al. Higher rate of perineural invasion in stent-laparoscopic approach in comparison to emergent open resection for obstructing left-sided colon cancer. Int J Colorectal Dis, 2013, 28(3): 407-414.
39.	Hu Y, Fan J, Xv Y, et al. 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, 20(1): 255.
40.	Al-Sukhni E, Attwood K, Gabriel EM, et al. Lymphovascular and perineural invasion are associated with poor prognostic features and outcomes in colorectal cancer: a retrospective cohort study. Int J Surg, 2017, 37: 42-49.
41.	Huh JW, Lee JH, Kim HR, et al. Prognostic significance of lymphovascular or perineural invasion in patients with locally advanced colorectal cancer. Am J Surg, 2013, 206(5): 758-763.
42.	Mohammadi H, Sahai E. Mechanisms and impact of altered tumour mechanics. Nat Cell Biol, 2018, 20(7): 766-774.
43.	Tse JM, Cheng G, Tyrrell JA, et al. Mechanical compression drives cancer cells toward invasive phenotype. Proc Natl Acad Sci U S A, 2012, 109(3): 911-916.
44.	Chen SH, Zhang BY, Zhou B, et al. Perineural invasion of cancer: a complex crosstalk between cells and molecules in the perineural niche. Am J Cancer Res, 2019, 9(1): 1-21.
45.	Grivennikov SI, Greten FR, Karin M. Immunity, inflammation, and cancer. Cell, 2010, 140(6): 883-899.
46.	Broholm M, Kobborg M, Frostberg E, et al. Delay of surgery after stent placement for resectable malignant colorectal obstruction is associated with higher risk of recurrence. Int J Colorectal Dis, 2017, 32(4): 513-516.
47.	Suen MK, Zahid A, Young JM, et al. How to decide to undertake a randomized, controlled trial of stent or surgery in colorectal obstruction. Surgery, 2015, 157(6): 1137-1141.
48.	Bruni D, Angell HK, Galon J. The immune contexture and Immunoscore in cancer prognosis and therapeutic efficacy. Nat Rev Cancer, 2020, 20(11): 662-680.
49.	Chan JC, Chan DL, Diakos CI, et al. The lymphocyte-to-monocyte ratio is a superior predictor of overall survival in comparison to established biomarkers of resectable colorectal cancer. Ann Surg, 2017, 265(3): 539-546.
50.	Rossi S, Basso M, Strippoli A, et al. Are markers of systemic inflammation good prognostic indicators in colorectal cancer?. Clin Colorectal Cancer, 2017, 16(4): 264-274.
51.	Chen JH, Zhai ET, Yuan YJ, et al. Systemic immune-inflammation index for predicting prognosis of colorectal cancer. World J Gastroenterol, 2017, 23(34): 6261-6272.
52.	金永杰. 左半结肠癌伴急性肠梗阻行肠道支架序贯手术治疗预后的研究. 沈阳: 中国医科大学, 2014.
53.	Delarue M, Montel F, Vignjevic D, et al. Compressive stress inhibits proliferation in tumor spheroids through a volume limitation. Biophys J, 2014, 107(8): 1821-1828.
54.	Matsuda A, Miyashita M, Matsumoto S, et al. Optimal interval from placement of a self-expandable metallic stent to surgery in patients with malignant large bowel obstruction: a preliminary study. Surg Laparosc Endosc Percutan Tech, 2018, 28(4): 239-244.
55.	Zanotelli MR, Reinhart-King CA. Mechanical forces in tumor angiogenesis. Adv Exp Med Biol, 2018, 1092: 91-112.
56.	Belluco C, Esposito G, Bertorelle R, et al. Absence of the cell cycle inhibitor p27Kip1 protein predicts poor outcome in patients with stage I-III colorectal cancer. Ann Surg Oncol, 1999, 6(1): 19-25.
57.	Choi SH, Barker EC, Gerber KJ, et al. Loss of p27Kip1 leads to expansion of CD4+ effector memory T cells and accelerates colitis-associated colon cancer in mice with a T cell lineage restricted deletion of Smad4. Oncoimmunology, 2020, 9(1): 1847832.
58.	Amelung FJ, Borstlap WAA, Consten ECJ, et al. Propensity score-matched analysis of oncological outcome between stent as bridge to surgery and emergency resection in patients with malignant left-sided colonic obstruction. Br J Surg, 2019, 106(8): 1075-1086.
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1. 吴春晓, 顾凯, 龚杨明, 等. 2015 年中国结直肠癌发病和死亡情况分析. 中国癌症杂志, 2020, 30(4): 241-245.
2. Baer C, Menon R, Bastawrous S, et al. Emergency presentations of colorectal cancer. Surg Clin North Am, 2017, 97(3): 529-545.
3. Pisano M, Zorcolo L, Merli C, et al. 2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation. World J Emerg Surg, 2018, 13: 36.
4. Cappell MS, Batke M. Mechanical obstruction of the small bowel and colon. Med Clin North Am, 2008, 92(3): 575-597, viii.
5. Smith DA, Kashyap S, Nehring SM. Bowel obstruction//StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2022: 5.
6. Ormando VM, Palma R, Fugazza A, et al. Colonic stents for malignant bowel obstruction: current status and future prospects. Expert Rev Med Devices, 2019, 16(12): 1053-1061.
7. Sasaki T, Ishibashi R, Yoshida S, et al. Comparing the mechanical properties of a self-expandable metallic stent for colorectal obstruction: proposed measurement method of axial force using a new measurement machine. Dig Endosc, 2021, 33(1): 170-178.
8. Bethge N, Sommer A, Gross U, et al. Human tissue responses to metal stents implanted in vivo for the palliation of malignant stenoses. Gastrointest Endosc, 1996, 43(6): 596-602.
9. Vakil N. Expandable metal stents: principles and tissue responses. Gastrointest Endosc Clin N Am, 2011, 21(3): 351-357, vii.
10. Fryer E, Gorissen KJ, Wang LM, et al. Spectrum of histopathological changes encountered in stented colorectal carcinomas. Histopathology, 2015, 66(4): 480-484.
11. Amini N, Haydel D, Reisian N, et al. Colorectal stents orient specimens and induce artifacts that mimic Crohn disease. Int J Surg Pathol, 2012, 20(2): 161-168.
12. Cheung DY, Lee YK, Yang CH. Status and literature review of self-expandable metallic stents for malignant colorectal obstruction. Clin Endosc, 2014, 47(1): 65-73.
13. Datye A, Hersh J. Colonic perforation after stent placement for malignant colorectal obstruction-causes and contributing factors. Minim Invasive Ther Allied Technol, 2011, 20(3): 133-140.
14. Small AJ, Coelho-Prabhu N, Baron TH. Endoscopic placement of self-expandable metal stents for malignant colonic obstruction: long-term outcomes and complication factors. Gastrointest Endosc, 2010, 71(3): 560-572.
15. Lee JM, Byeon JS. Colorectal stents: current status. Clin Endosc, 2015, 48(3): 194-200.
16. Choi JH, Lee YJ, Kim ES, et al. Covered self-expandable metal stents are more associated with complications in the management of malignant colorectal obstruction. Surg Endosc, 2013, 27(9): 3220-3227.
17. Sebastian S, Johnston S, Geoghegan T, et al. Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol, 2004, 99(10): 2051-2057.
18. van Hooft JE, van Halsema EE, Vanbiervliet G, et al. Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Gastrointest Endosc, 2014, 80(5): 747-775.
19. Kim SJ, Kim HW, Park SB, et al. Colonic perforation either during or after stent insertion as a bridge to surgery for malignant colorectal obstruction increases the risk of peritoneal seeding. Surg Endosc, 2015, 29(12): 3499-3506.
20. Zanghì A, Piccolo G, Cavallaro A, et al. A pilot study about the oncologic safety of colonic self-expandable metal stents (SEMS) in obstructive colon cancer: is occlusion always better than “silent” perforation?. Eur Rev Med Pharmacol Sci, 2016, 20(24): 5242-5248.
21. Sloothaak DA, van den Berg MW, Dijkgraaf MG, et al. Oncological outcome of malignant colonic obstruction in the Dutch Stent-In 2 trial. Br J Surg, 2014, 101(13): 1751-1757.
22. Chan DKH, Tan KK. Stenting versus surgery in obstructed malignant colorectal cancer-a review of short and long-term results. J Gastrointest Oncol, 2020, 11(3): 486-490.
23. Costa Santos MP, Palmela C, Ferreira R, et al. Self-expandable metal stents for colorectal cancer: from guidelines to clinical practice. GE Port J Gastroenterol, 2016, 23(6): 293-299.
24. Cao Y, Deng S, Wu K, et al. Oncological consequence of emergent resection of perforated colon cancer with complete obstruction after stent insertion as a bridge to surgery. Int J Colorectal Dis, 2019, 34(3): 545-547.
25. Cennamo V, Fuccio L, Mutri V, et al. Does stent placement for advanced colon cancer increase the risk of perforation during bevacizumab-based therapy?. Clin Gastroenterol Hepatol, 2009, 7(11): 1174-1176.
26. Imbulgoda A, MacLean A, Heine J, et al. Colonic perforation with intraluminal stents and bevacizumab in advanced colorectal cancer: retrospective case series and literature review. Can J Surg, 2015, 58(3): 167-171.
27. Matsuda A, Yamada T, Matsumoto S, et al. Systemic chemotherapy is a promising treatment option for patients with colonic stents: a review. J Anus Rectum Colon, 2021, 5(1): 1-10.
28. Pacheco-Barcia V, Mondéjar R, Martínez-Sáez O, et al. Safety and oncological outcomes of bevacizumab therapy in patients with advanced colorectal cancer and self-expandable metal stents. Clin Colorectal Cancer, 2019, 18(3): e287-e293.
29. Tanaka I, Hisai H, Miyazaki E, et al. A case of delayed colonic perforation after metallic stent placement for advanced descending colon cancer during bevacizumab-based chemotherapy. Gan To Kagaku Ryoho, 2011, 38(12): 2319-2321.
30. Maruthachalam K, Lash GE, Shenton BK, et al. Tumour cell dissemination following endoscopic stent insertion. Br J Surg, 2007, 94(9): 1151-1154.
31. Takahashi G, Yamada T, Iwai T, et al. Oncological assessment of stent placement for obstructive colorectal cancer from circulating cell-free DNA and circulating tumor DNA dynamics. Ann Surg Oncol, 2018, 25(3): 737-744.
32. Ishibashi R, Yoshida S, Odawara N, et al. Detection of circulating colorectal cancer cells by a custom microfluid system before and after endoscopic metallic stent placement. Oncol Lett, 2019, 18(6): 6397-6404.
33. Yamashita S, Tanemura M, Sawada G, et al. Impact of endoscopic stent insertion on detection of viable circulating tumor cells from obstructive colorectal cancer. Oncol Lett, 2018, 15(1): 400-406.
34. Joyce JA, Pollard JW. Microenvironmental regulation of metastasis. Nat Rev Cancer, 2009, 9(4): 239-252.
35. Chen XQ, Xue CR, Hou P, et al. Lymphocyte-to-monocyte ratio effectively predicts survival outcome of patients with obstructive colorectal cancer. World J Gastroenterol, 2019, 25(33): 4970-4984.
36. Haraguchi N, Ikeda M, Miyake M, et al. Colonic stenting as a bridge to surgery for obstructive colorectal cancer: advantages and disadvantages. Surg Today, 2016, 46(11): 1310-1317.
37. Kang SI, Oh HK, Yoo JS, et al. Oncologic outcomes of preoperative stent insertion first versus immediate surgery for obstructing left-sided colorectal cancer. Surg Oncol, 2018, 27(2): 216-224.
38. Kim HJ, Choi GS, Park JS, et al. Higher rate of perineural invasion in stent-laparoscopic approach in comparison to emergent open resection for obstructing left-sided colon cancer. Int J Colorectal Dis, 2013, 28(3): 407-414.
39. Hu Y, Fan J, Xv Y, et al. 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, 20(1): 255.
40. Al-Sukhni E, Attwood K, Gabriel EM, et al. Lymphovascular and perineural invasion are associated with poor prognostic features and outcomes in colorectal cancer: a retrospective cohort study. Int J Surg, 2017, 37: 42-49.
41. Huh JW, Lee JH, Kim HR, et al. Prognostic significance of lymphovascular or perineural invasion in patients with locally advanced colorectal cancer. Am J Surg, 2013, 206(5): 758-763.
42. Mohammadi H, Sahai E. Mechanisms and impact of altered tumour mechanics. Nat Cell Biol, 2018, 20(7): 766-774.
43. Tse JM, Cheng G, Tyrrell JA, et al. Mechanical compression drives cancer cells toward invasive phenotype. Proc Natl Acad Sci U S A, 2012, 109(3): 911-916.
44. Chen SH, Zhang BY, Zhou B, et al. Perineural invasion of cancer: a complex crosstalk between cells and molecules in the perineural niche. Am J Cancer Res, 2019, 9(1): 1-21.
45. Grivennikov SI, Greten FR, Karin M. Immunity, inflammation, and cancer. Cell, 2010, 140(6): 883-899.
46. Broholm M, Kobborg M, Frostberg E, et al. Delay of surgery after stent placement for resectable malignant colorectal obstruction is associated with higher risk of recurrence. Int J Colorectal Dis, 2017, 32(4): 513-516.
47. Suen MK, Zahid A, Young JM, et al. How to decide to undertake a randomized, controlled trial of stent or surgery in colorectal obstruction. Surgery, 2015, 157(6): 1137-1141.
48. Bruni D, Angell HK, Galon J. The immune contexture and Immunoscore in cancer prognosis and therapeutic efficacy. Nat Rev Cancer, 2020, 20(11): 662-680.
49. Chan JC, Chan DL, Diakos CI, et al. The lymphocyte-to-monocyte ratio is a superior predictor of overall survival in comparison to established biomarkers of resectable colorectal cancer. Ann Surg, 2017, 265(3): 539-546.
50. Rossi S, Basso M, Strippoli A, et al. Are markers of systemic inflammation good prognostic indicators in colorectal cancer?. Clin Colorectal Cancer, 2017, 16(4): 264-274.
51. Chen JH, Zhai ET, Yuan YJ, et al. Systemic immune-inflammation index for predicting prognosis of colorectal cancer. World J Gastroenterol, 2017, 23(34): 6261-6272.
52. 金永杰. 左半结肠癌伴急性肠梗阻行肠道支架序贯手术治疗预后的研究. 沈阳: 中国医科大学, 2014.
53. Delarue M, Montel F, Vignjevic D, et al. Compressive stress inhibits proliferation in tumor spheroids through a volume limitation. Biophys J, 2014, 107(8): 1821-1828.
54. Matsuda A, Miyashita M, Matsumoto S, et al. Optimal interval from placement of a self-expandable metallic stent to surgery in patients with malignant large bowel obstruction: a preliminary study. Surg Laparosc Endosc Percutan Tech, 2018, 28(4): 239-244.
55. Zanotelli MR, Reinhart-King CA. Mechanical forces in tumor angiogenesis. Adv Exp Med Biol, 2018, 1092: 91-112.
56. Belluco C, Esposito G, Bertorelle R, et al. Absence of the cell cycle inhibitor p27Kip1 protein predicts poor outcome in patients with stage I-III colorectal cancer. Ann Surg Oncol, 1999, 6(1): 19-25.
57. Choi SH, Barker EC, Gerber KJ, et al. Loss of p27Kip1 leads to expansion of CD4+ effector memory T cells and accelerates colitis-associated colon cancer in mice with a T cell lineage restricted deletion of Smad4. Oncoimmunology, 2020, 9(1): 1847832.
58. Amelung FJ, Borstlap WAA, Consten ECJ, et al. Propensity score-matched analysis of oncological outcome between stent as bridge to surgery and emergency resection in patients with malignant left-sided colonic obstruction. Br J Surg, 2019, 106(8): 1075-1086.
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