{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T20:58:39Z","timestamp":1785445119727,"version":"3.56.0"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":21,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World J Surg Onc"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The optimal management of stage IV colorectal cancer with malignant large bowel obstruction remains controversial. Self-expandable metallic stents are an established bridge to surgery in non-metastatic disease, but the role of primary tumor resection after stent placement in stage IV patients is unresolved. We propose and evaluate a \u201cquasi-bridge to surgery\u201d (Quasi-BTS) strategy in which stenting serves as a biological selection tool to identify patients who may benefit from delayed primary tumor resection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center retrospective cohort study analyzed consecutive stage IV obstructive colorectal cancer patients who underwent successful self-expandable metallic stent placement between January 2007 and December 2023. Patients were categorized into a Quasi-BTS group (delayed primary tumor resection), a palliative chemotherapy-only group, and palliative care-only group. Primary outcomes were overall survival, stent-related complications, and stoma-free survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifty-three patients were analyzed (Quasi-BTS,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200916; palliative chemotherapy only,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200922; palliative care only,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200915). The Quasi-BTS group had zero overall stent-related complications versus 46.7% and 36.4% in the palliative care-only and palliative chemotherapy-only groups, respectively (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.009); perforation alone was a non-significant trend (0% vs. 26.7% vs. 27.3%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.070). The laparoscopic surgery rate was 82%, the primary anastomosis rate was 92%, and bevacizumab was safely administered in all 6 patients who received it. Overall survival was significantly longer in the Quasi-BTS group than in either palliative group (log-rank all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). After multivariable Cox adjustment for age, ASA, metastatic site, and targeted-therapy use, the Quasi-BTS group retained a markedly reduced hazard of death (adjusted HR 0.037, 95% CI 0.010\u20130.135). The mean interval from stent insertion to resection was 21.2 days in the resection-first subgroup.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The Quasi-BTS strategy may extend the bridge-to-surgery concept to metastatic colorectal cancer by repurposing stenting as a bridge for patient selection. Performing primary tumor resection within approximately three months of stent insertion was associated with the absence of stent-related complications in our cohort, appears to permit the subsequent use of anti-angiogenic targeted therapy without observed stent-related complications, and was associated with improved long-term survival.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12957-026-04492-3","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T14:33:15Z","timestamp":1783607595000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A quasi-bridge to surgery approach for stage IV obstructive colon cancer: extending the bridge-to-surgery concept to metastatic disease"],"prefix":"10.1186","volume":"24","author":[{"given":"Shu-Huan","family":"Huang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sum-Fu","family":"Chiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kun-Yu","family":"Tsai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pao-Shiu","family":"Hsieh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeng-Fu","family":"You","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4819-2104","authenticated-orcid":false,"given":"Cheng-Chou","family":"Lai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"issue":"3","key":"4492_CR1","first-page":"229","volume":"74","author":"F Bray","year":"2024","unstructured":"Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229\u201363.","journal-title":"CA Cancer J Clin"},{"issue":"11","key":"4492_CR2","doi-asserted-by":"publisher","first-page":"3660","DOI":"10.1245\/s10434-016-5247-7","volume":"23","author":"FJ Amelung","year":"2016","unstructured":"Amelung FJ, Consten ECJ, Siersema PD, Tanis PJ. A population-based analysis of three treatment modalities for malignant obstruction of the proximal colon: acute resection versus stent or stoma as a bridge to surgery. Ann Surg Oncol. 2016;23(11):3660\u20138.","journal-title":"Ann Surg Oncol"},{"key":"4492_CR3","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1186\/s13017-018-0192-3","volume":"13","author":"M Pisano","year":"2018","unstructured":"Pisano M, Zorcolo L, Merli C, Cimbanassi S, Poiasina E, Ceresoli M, et al. 2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation. World J Emerg Surg. 2018;13:36.","journal-title":"World J Emerg Surg"},{"issue":"2","key":"4492_CR4","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1007\/s00464-005-0644-1","volume":"21","author":"HS Tilney","year":"2007","unstructured":"Tilney HS, Lovegrove RE, Purkayastha S, Sains PS, Weston-Petrides GK, Darzi AW, et al. Comparison of colonic stenting and open surgery for malignant large bowel obstruction. Surg Endosc. 2007;21(2):225\u201333.","journal-title":"Surg Endosc"},{"issue":"2","key":"4492_CR5","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1245\/s10434-014-3997-7","volume":"22","author":"A Matsuda","year":"2015","unstructured":"Matsuda A, Miyashita M, Matsumoto S, Matsutani T, Sakurazawa N, Takahashi G, et al. Comparison of long-term outcomes of colonic stent as bridge to surgery and emergency surgery for malignant large-bowel obstruction: a meta-analysis. Ann Surg Oncol. 2015;22(2):497\u2013504.","journal-title":"Ann Surg Oncol"},{"issue":"3","key":"4492_CR6","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1016\/j.gie.2017.03.1542","volume":"86","author":"A Arezzo","year":"2017","unstructured":"Arezzo A, Passera R, Lo Secco G, Verra M, Bonino MA, Targarona E, et al. Stent as bridge to surgery for left-sided malignant colonic obstruction reduces adverse events and stoma rate compared with emergency surgery: results of a systematic review and meta-analysis of randomized controlled trials. Gastrointest Endosc. 2017;86(3):416\u201326.","journal-title":"Gastrointest Endosc"},{"issue":"5","key":"4492_CR7","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1007\/s11894-010-0136-x","volume":"12","author":"EA Bonin","year":"2010","unstructured":"Bonin EA, Baron TH. Update on the indications and use of colonic stents. Curr Gastroenterol Rep. 2010;12(5):374\u201382.","journal-title":"Curr Gastroenterol Rep"},{"issue":"10","key":"4492_CR8","doi-asserted-by":"publisher","first-page":"2051","DOI":"10.1111\/j.1572-0241.2004.40017.x","volume":"99","author":"S Sebastian","year":"2004","unstructured":"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;99(10):2051\u20137.","journal-title":"Am J Gastroenterol"},{"issue":"11","key":"4492_CR9","doi-asserted-by":"publisher","first-page":"1073","DOI":"10.1093\/bjs\/znac141","volume":"109","author":"J Hill","year":"2022","unstructured":"Hill J, Kay C, Morton D, Magill L, Handley K, Gray RG, et al. CReST: Randomised phase III study of stenting as a bridge to surgery in obstructing colorectal cancer \u2014 results of the UK Colorectal Endoscopic Stenting Trial (CReST). Br J Surg. 2022;109(11):1073\u201380.","journal-title":"Br J Surg"},{"issue":"3","key":"4492_CR10","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1001\/jamasurg.2019.5466","volume":"155","author":"JV Veld","year":"2020","unstructured":"Veld JV, Amelung FJ, Borstlap WAA, van Halsema EE, Consten ECJ, Siersema PD, et al. Comparison of decompressing stoma vs stent as a bridge to surgery for left-sided obstructive colon cancer. JAMA Surg. 2020;155(3):206\u201315.","journal-title":"JAMA Surg"},{"issue":"8","key":"4492_CR11","doi-asserted-by":"publisher","first-page":"1904","DOI":"10.1007\/s00268-011-1139-y","volume":"35","author":"M Alc\u00e1ntara","year":"2011","unstructured":"Alc\u00e1ntara M, Serra-Aracil X, Falc\u00f3 J, Mora L, Bombard\u00f3 J, Navarro S. Prospective, controlled, randomized study of intraoperative colonic lavage versus stent placement in obstructive left-sided colonic cancer. World J Surg. 2011;35(8):1904\u201310.","journal-title":"World J Surg"},{"issue":"5","key":"4492_CR12","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1055\/a-1140-3017","volume":"52","author":"JE van Hooft","year":"2020","unstructured":"van Hooft JE, Veld JV, Arnold D, Beets-Tan RGH, Everett S, Gotz M, et al. Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) guideline \u2014 update 2020. Endoscopy. 2020;52(5):389\u2013407.","journal-title":"Endoscopy"},{"issue":"5","key":"4492_CR13","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1002\/cncr.28464","volume":"120","author":"S Ahmed","year":"2014","unstructured":"Ahmed S, Leis A, Fields A, Chandra-Kanthan S, Haider K, Alvi R, et al. Survival impact of surgical resection of primary tumor in patients with stage IV colorectal cancer: results from a large population-based cohort study. Cancer. 2014;120(5):683\u201391.","journal-title":"Cancer"},{"issue":"2","key":"4492_CR14","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1016\/j.ejca.2014.10.023","volume":"51","author":"M Faron","year":"2015","unstructured":"Faron M, Pignon JP, Malka D, Bourredjem A, Douillard JY, Adenis A, et al. Is primary tumour resection associated with survival improvement in patients with colorectal cancer and unresectable synchronous metastases? A pooled analysis of individual data from four randomized trials. Eur J Cancer. 2015;51(2):166\u201376.","journal-title":"Eur J Cancer"},{"issue":"10","key":"4492_CR15","doi-asserted-by":"publisher","first-page":"1098","DOI":"10.1200\/JCO.20.02447","volume":"39","author":"Y Kanemitsu","year":"2021","unstructured":"Kanemitsu Y, Shitara K, Mizusawa J, Hamaguchi T, Shida D, Komori K, et al. Primary tumor resection plus chemotherapy versus chemotherapy alone for colorectal cancer patients with asymptomatic, synchronous unresectable metastases (JCOG1007; iPACS): a randomized clinical trial. J Clin Oncol. 2021;39(10):1098\u2013107.","journal-title":"J Clin Oncol"},{"issue":"13","key":"4492_CR16","doi-asserted-by":"publisher","first-page":"1531","DOI":"10.1200\/JCO.23.01540","volume":"42","author":"JA Bridgewater","year":"2024","unstructured":"Bridgewater JA, Pugh SA, Rawcliffe CL, Sharma RA, Primrose JN. Combined analysis of SYNCHRONOUS and CCRe-IV randomized trials: primary tumor resection for patients with unresectable metastatic colorectal cancer. J Clin Oncol. 2024;42(13):1531\u201341.","journal-title":"J Clin Oncol"},{"issue":"12","key":"4492_CR17","first-page":"1117","volume":"156","author":"NN Rahbari","year":"2021","unstructured":"Rahbari NN, Biondo S, Fei\u00dft M, Bruckner T, Rossion I, Luntz SP, et al. Primary tumor resection before systemic therapy in patients with colon cancer and unresectable synchronous metastases: sixty-day mortality results of the CAIRO4 phase 3 randomized clinical trial. JAMA Surg. 2021;156(12):1117\u201327.","journal-title":"JAMA Surg"},{"issue":"6","key":"4492_CR18","doi-asserted-by":"publisher","first-page":"970","DOI":"10.1016\/j.gie.2013.11.038","volume":"79","author":"EE van Halsema","year":"2014","unstructured":"van Halsema EE, van Hooft JE, Small AJ, Baron TH, Garc\u00eda-Cano J, Cheon JH, et al. Perforation in colorectal stenting: a meta-analysis and a search for risk factors. Gastrointest Endosc. 2014;79(6):970\u201382.","journal-title":"Gastrointest Endosc"},{"issue":"10","key":"4492_CR19","doi-asserted-by":"publisher","first-page":"1157","DOI":"10.1001\/archsurg.2011.233","volume":"146","author":"G Manes","year":"2011","unstructured":"Manes G, de Bellis M, Fuccio L, Repici A, Masci E, Ardizzone S, et al. Endoscopic palliation in patients with incurable malignant colorectal obstruction by means of self-expanding metal stent: analysis of results and predictors of outcomes in a large multicenter series. Arch Surg. 2011;146(10):1157\u201362.","journal-title":"Arch Surg"},{"key":"4492_CR20","volume-title":"NCCN clinical practice guidelines in oncology: colon cancer, version 3.2024","author":"National Comprehensive Cancer Network","year":"2024","unstructured":"National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: colon cancer, version 3.2024. Plymouth Meeting (PA): NCCN; 2024."},{"issue":"1","key":"4492_CR21","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1016\/j.annonc.2022.10.003","volume":"34","author":"A Cervantes","year":"2023","unstructured":"Cervantes A, Adam R, Rosell\u00f3 S, Arnold D, Normanno N, Taieb J, et al. Metastatic colorectal cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up. Ann Oncol. 2023;34(1):10\u201332.","journal-title":"Ann Oncol"},{"issue":"3","key":"4492_CR22","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1016\/j.gie.2009.10.012","volume":"71","author":"AJ Small","year":"2010","unstructured":"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\u201372.","journal-title":"Gastrointest Endosc"},{"issue":"3","key":"4492_CR23","doi-asserted-by":"publisher","first-page":"705","DOI":"10.1016\/j.gie.2017.05.032","volume":"87","author":"B Verstockt","year":"2018","unstructured":"Verstockt B, Van Driessche A, De Man M, van der Spek P, Hindryckx P, Ferrante M, et al. Ten-year survival after endoscopic stent placement as a bridge to surgery in obstructing colon cancer. Gastrointest Endosc. 2018;87(3):705\u201313.","journal-title":"Gastrointest Endosc"},{"issue":"7","key":"4492_CR24","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1089\/lap.2024.0050","volume":"34","author":"A Sekioka","year":"2024","unstructured":"Sekioka A, Takahashi T, Ueki H, Terasaki M, Yorifuji N, Iwai N, et al. Long-term outcomes of self-expandable metallic stents as a bridge to surgery for obstructive and symptomatic primary tumors of stage IV colorectal cancer: a propensity-score analysis. J Laparoendosc Adv Surg Tech. 2024;34(7):561\u20137.","journal-title":"J Laparoendosc Adv Surg Tech"},{"issue":"5","key":"4492_CR25","doi-asserted-by":"publisher","first-page":"1013","DOI":"10.1093\/annonc\/mdp449","volume":"21","author":"AS Strimpakos","year":"2010","unstructured":"Strimpakos AS, Cunningham D, Mikropoulos C, Petkar I, Barbachano Y, Chau I. The impact of carcinoembryonic antigen flare in patients with advanced colorectal cancer receiving first-line chemotherapy. Ann Oncol. 2010;21(5):1013\u20139.","journal-title":"Ann Oncol"},{"issue":"1","key":"4492_CR26","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1016\/j.suronc.2012.10.003","volume":"22","author":"R Cirocchi","year":"2013","unstructured":"Cirocchi R, Farinella E, Trastulli S, Desiderio J, Listorti C, Boselli C, et al. Safety and efficacy of endoscopic colonic stenting as a bridge to surgery in the management of intestinal obstruction due to left colon and rectal cancer: a systematic review and meta-analysis. Surg Oncol. 2013;22(1):14\u201321.","journal-title":"Surg Oncol"}],"container-title":["World Journal of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12957-026-04492-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12957-026-04492-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12957-026-04492-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T20:05:20Z","timestamp":1785441920000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12957-026-04492-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,9]]},"references-count":26,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4492"],"URL":"https:\/\/doi.org\/10.1186\/s12957-026-04492-3","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-9993777\/v1","asserted-by":"object"}]},"ISSN":["1477-7819"],"issn-type":[{"value":"1477-7819","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,9]]},"assertion":[{"value":"10 June 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was approved by the Institutional Review Board of Chang Gung Memorial Hospital (IRB No. 202501451B0) and conducted in accordance with the Declaration of Helsinki. Given the retrospective nature of the analysis and the use of de-identified data, the requirement for written informed consent was waived by the Institutional Review Board.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable. The manuscript contains no individual person\u2019s data in any form.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"315"}}