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Response to Re: Outcome of bridge to surgery stenting for obstructive left colon cancer

We really appreciate the valuable comments and analyses by Sabbagh et al. When comparing the treatment outcomes between emergency surgery (ES) and the bridge to surgery using self-expandable metallic stent (SEMS) for obstructing colon cancer, we must consider two aspects: perioperative recovery and long-term oncological outcomes. As Sabbagh et al. commented, some researchers demonstrated that the placement of SEMS for obstructing colon cancer resulted in unfavourable oncological outcomes. Nevertheless, there are some reasons they would decide on the placement of SEMS for obstructing colon cancer: medically inoperable patients’ condition, to avoid multiple staged surgeries (especially for left-sided colon obstruction) and post-operative morbidity, to provide enough preoperative resuscitation and so on. In other words, the preference of SEMS would be intended to achieve favourable perioperative outcomes. We mentioned some factors related to long-term outcomes in the Discussion section of our original article. Besides, surgeon’s factor might be considered as an important factor; most surgeries after SEMS were performed by colorectal surgeons, but a certain portion of ESs by general surgeons. These affect the number of harvested lymph nodes and adequate surgical margins, which might mean a radicality or completeness of curative surgery. In Table 4 of our original article, ES group had a shorter distal resection margin and a lower rate of retrieving more than 12 lymph nodes than the SEMS group. We think that these factors might bring poorer oncological outcomes of the ES group than those from meta-analysis which Sabbagh et al. mentioned. In our original article, we intended to emphasize the role of SEMS as an alternative procedure for left-sided colon cancer obstruction, and not a standard procedure. We suggest that the bridge to surgery after SEMS may be a good alternative treatment option which has favourable perioperative outcome for left-sided colon cancer obstruction, especially when ES is not available or appropriate.