|
1
|
Malik S, Loganathan P, Khan H, Shadali AH, Yarra P, Chandan S, Mohan BP, Adler DG, Kothari S. Transforming outcomes: the pivotal role of self-expanding metal stents in right- and left-sided malignant colorectal obstructions-bridge to surgery: a comprehensive review and meta-analysis. Clin Endosc 2025; 58:240-252. [PMID: 39895121 PMCID: PMC11983139 DOI: 10.5946/ce.2024.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/25/2024] [Accepted: 07/10/2024] [Indexed: 02/04/2025] Open
Abstract
BACKGROUND/AIMS Self-expanding metallic stents (SEMS) are an alternative to emergency surgery (ES) for malignant colorectal obstruction. This study aimed to compare surgical outcomes between SEMS as a bridge to surgery (BTS) and ES in patients with malignant colorectal obstruction. METHODS A comprehensive database search was conducted until October 2023 to compare outcomes between SEMS as a BTS and ES. A subgroup analysis of results by malignancy site was performed. RESULTS We analyzed 57 studies, including 7,223 patients over a mean duration of 35.4 months. SEMS as a BTS showed clinical and technical success rates of 88.0% (95% confidence interval [CI], 86.1%-90.1%; I2=68%) and 91.6% (95% CI, 89.7%-93.7%; I2=66%), respectively. SEMS as a BTS revealed reduced postoperative adverse events (odds ratio [OR], 0.51; 95% CI, 0.41-0.63; I2=70%; p<0.001) and 30-day mortality (OR, 0.52; 95% CI, 0.37-0.72; I2=10%; p<0.001) compared to ES. Subgroup analysis showed postoperative mortality of 5% and 1.5% for left- and right-sided malignancies, respectively. Adverse events were 15% and 33% for the right and left colon, respectively. CONCLUSIONS SEMS as a BTS demonstrated a higher success rate, fewer postoperative adverse events, and a reduced 30-day mortality rate than ES, supporting its use as the preferred initial intervention for right- and left-sided obstructions and indicating broader clinical adoption.
Collapse
Affiliation(s)
- Sheza Malik
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | | | - Hajra Khan
- Department of Internal Medicine, Rawalpindi Medical College, Rawalpindi, Pakistan
| | - Abul Hasan Shadali
- Department of Internal Medicine, Government Kilpauk Medical College, Chennai, India
| | - Pradeep Yarra
- Department of Gastroenterology and Hepatology, Saint Louis University, St. Louis, MO, USA
| | - Saurabh Chandan
- Department of Gastroenterology and Hepatology, CHI Creighton Medical Center, Omaha, NE, USA
| | - Babu P. Mohan
- Department of Gastroenterology and Hepatology, Orlando Gastroenterology PA, Orlando, FL, USA
| | - Douglas G. Adler
- Department of Gastroenterology and Hepatology, Center for Advanced Therapeutic Endoscopy, Centura Health, Denver, CO, USA
| | - Shivangi Kothari
- Department of Gastroenterology and Hepatology, University of Rochester, Rochester, NY, USA
| |
Collapse
|
|
2
|
Marzano M, Prosperi P, Grazi GL, Cianchi F, Talamucci L, Bisogni D, Bencini L, Mastronardi M, Guagni T, Falcone A, Martellucci J, Bergamini C, Giordano A. Upfront Surgery vs. Endoscopic Stenting Bridge to Minimally Invasive Surgery for Treatment of Obstructive Left Colon Cancer: Analysis of Surgical and Oncological Outcomes. Cancers (Basel) 2024; 16:3895. [PMID: 39682083 PMCID: PMC11640554 DOI: 10.3390/cancers16233895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Revised: 11/14/2024] [Accepted: 11/20/2024] [Indexed: 12/18/2024] Open
Abstract
BACKGROUND Left colon cancer obstruction treatment is a debated topic in the literature. Stent placement is effective as a bridge-to-surgery strategy, but there are some concerns about the oncological safety for the reported higher risk of local and peritoneal recurrence. This study aims to compare the surgical and oncological outcomes of patients treated with stent followed by elective surgery with those treated with primary resection. METHODS This is a retrospective observational study. We included patients of both sexes, ≥18 years old, with a histological diagnosis of intestinal adenocarcinoma, and admitted to our hospital for left colon cancer obstruction demonstrated by CT scan without metastasis or perforation. They were treated through primary resection (PR) or stent placement followed by elective surgery (SR). The two groups were compared for general characteristics, surgical outcomes, and oncological outcomes (metastasis and local recurrence) at 30 days, 90 days, 1 year, and 3 years. Post-operative quality of life (QoL) was also investigated. RESULTS The SR group showed a shorter hospital stay, a lower post-operative mortality, a lower stoma rate at 1 year, and a higher number of minimally invasive procedures. Oncological outcomes were not different compared to the PR group. The SR group demonstrated better QoL in two out of six items on the EQ-5D-5L test. CONCLUSIONS Stent placement as a bridge-to-surgery strategy is feasible and provides better surgical outcomes in terms of post-operative complications, surgical approach, stoma rate, and QoL. Oncological outcomes were not reported differently, but further studies should be conducted to better evaluate this aspect.
Collapse
Affiliation(s)
- Mauro Marzano
- Emergency Surgery Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy (P.P.); (J.M.)
| | - Paolo Prosperi
- Emergency Surgery Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy (P.P.); (J.M.)
| | - Gian Luca Grazi
- Hepatobiliary Pancreatic Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy;
| | - Fabio Cianchi
- Digestive System Surgery Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy;
| | - Luca Talamucci
- Advanced Interventional Endoscopy Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy; (L.T.); (D.B.)
| | - Damiano Bisogni
- Advanced Interventional Endoscopy Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy; (L.T.); (D.B.)
| | - Lapo Bencini
- General Surgery Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy;
| | - Manuela Mastronardi
- Department of Medicine, Surgery and Health Sciences, General Surgery Unit, University Hospital of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
| | - Tommaso Guagni
- Emergency Surgery Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy (P.P.); (J.M.)
| | - Agostino Falcone
- Emergency Surgery Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy (P.P.); (J.M.)
| | - Jacopo Martellucci
- Emergency Surgery Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy (P.P.); (J.M.)
| | - Carlo Bergamini
- Emergency Surgery Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy (P.P.); (J.M.)
| | - Alessio Giordano
- Emergency Surgery Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy (P.P.); (J.M.)
| |
Collapse
|
|
3
|
Huang X, Han X, Li W, Zhang J, Ma B, Wang Y, Yin Z, Gao L, Shi J, Maswikiti EP, Chen H. Case report: A clinical report of photodynamic neoadjuvant combined with fluorescent laparoscopic localization robotic surgery for the treatment of patients with advanced colorectal cancer combined with obstruction. Front Immunol 2024; 15:1403613. [PMID: 39295868 PMCID: PMC11409080 DOI: 10.3389/fimmu.2024.1403613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 08/15/2024] [Indexed: 09/21/2024] Open
Abstract
The incidence of colorectal cancer is relatively high in our country, with the majority of patients being diagnosed at an advanced stage. For individuals with advanced-stage colorectal cancer, conversion or neoadjuvant therapy is frequently necessitated to facilitate surgical intervention and achieve a curative effect. And about 10% to 30% of colon cancer patients are complicated with intestinal obstruction. Surgical intervention remains the primary treatment for managing intestinal obstructions, albeit with a considerable risk of perioperative mortality and an increased likelihood of postoperative complications. PDT, as a neoadjuvant treatment for colon cancer, can shrink the local tumor and relieve obstruction, and is effective in colon cancer combined with obstruction. Robotic surgery has the advantages of high stability and low trauma, and compared with laparoscopic colon cancer surgery, robotic surgery can achieve better results. Fluorescent laparoscopic clarifies the location and size of the tumor lesion, allowing for greater precision when removing colon cancer lesions in robotic surgery. Therefore, in the treatment of colon cancer, PDT can offer an opportunity for surgery after relieving obstruction in patients with obstructive colon cancer. Additionally, when combined with fluorescent laparoscopic robotic colon cancer surgery, it provides a novel treatment approach for patients with obstructive colon cancer. Preoperative photodynamic neoadjuvant therapy combined with robotic colon cancer surgery has not yet been reported. Here, we report a case of colon cancer with obstruction, preoperative TNM stage was T4N1, and the lesion had caused intestinal stenosis. After four sessions of PDT, the patient's intestinal lumen was unobstructed and the lesion had regressed. After evaluation, fluorescent laparoscopic localization and visualization of lymph nodes combined with robotic colon cancer resection were performed. Postoperative pathology showed that the patient's tumor regression grade was grade 1. The patient's tumor was completely resected with good resection effect. No tumor invasion was found on both sides of the resection margin, and the patient did not relapse after surgery.
Collapse
Affiliation(s)
- Xiaodong Huang
- The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, China
- Key Laboratory of the Digestive System Tumors of Gansu Province, The Second Hospital and Clinical Medical School, Lanzhou, China
| | - Xiaowen Han
- The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, China
- Key Laboratory of the Digestive System Tumors of Gansu Province, The Second Hospital and Clinical Medical School, Lanzhou, China
| | - Weidong Li
- The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, China
- Key Laboratory of the Digestive System Tumors of Gansu Province, The Second Hospital and Clinical Medical School, Lanzhou, China
| | - Jiayi Zhang
- The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, China
- Key Laboratory of the Digestive System Tumors of Gansu Province, The Second Hospital and Clinical Medical School, Lanzhou, China
| | - Bin Ma
- The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, China
- Key Laboratory of the Digestive System Tumors of Gansu Province, The Second Hospital and Clinical Medical School, Lanzhou, China
| | - Yuhan Wang
- The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, China
- Key Laboratory of the Digestive System Tumors of Gansu Province, The Second Hospital and Clinical Medical School, Lanzhou, China
| | - Zhenyu Yin
- The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, China
- Key Laboratory of the Digestive System Tumors of Gansu Province, The Second Hospital and Clinical Medical School, Lanzhou, China
| | - Lei Gao
- The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, China
- Key Laboratory of the Digestive System Tumors of Gansu Province, The Second Hospital and Clinical Medical School, Lanzhou, China
| | - Jianming Shi
- The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, China
- Key Laboratory of the Digestive System Tumors of Gansu Province, The Second Hospital and Clinical Medical School, Lanzhou, China
| | - Ewetse Paul Maswikiti
- The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, China
- Key Laboratory of the Digestive System Tumors of Gansu Province, The Second Hospital and Clinical Medical School, Lanzhou, China
| | - Hao Chen
- The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, China
- Key Laboratory of the Digestive System Tumors of Gansu Province, The Second Hospital and Clinical Medical School, Lanzhou, China
- Department of Surgical Oncology, Lanzhou University Second Hospital, Lanzhou, China
| |
Collapse
|
|
4
|
McHugh FT, Ryan ÉJ, Ryan OK, Tan J, Boland PA, Whelan MC, Kelly ME, McNamara D, Neary PC, O'Riordan JM, Kavanagh DO. Management Strategies for Malignant Left-Sided Colonic Obstruction: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials and Propensity Score Matching Studies. Dis Colon Rectum 2024; 67:878-894. [PMID: 38557484 DOI: 10.1097/dcr.0000000000003256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND The optimal treatment strategy for left-sided malignant colonic obstruction remains controversial. Emergency colonic resection has been the standard of care; however, self-expanding metallic stenting as a bridge to surgery may offer short-term advantages, although oncological concerns exist. Decompressing stoma may provide a valid alternative, with limited evidence. OBJECTIVE To perform a systematic review and Bayesian arm random-effects model network meta-analysis comparing the approaches for management of malignant left-sided colonic obstruction. DATA SOURCES A systematic review of PubMed, Embase, Cochrane Library, and Google Scholar databases was conducted from inception to August 22, 2023. STUDY SELECTION Randomized controlled trials and propensity score-matched studies. INTERVENTIONS Emergency colonic resection, self-expanding metallic stent, and decompressing stoma. MAIN OUTCOME MEASURES Oncologic efficacy, morbidity, successful minimally invasive surgery, primary anastomosis, and permanent stoma rates. RESULTS Nineteen of 5225 articles identified met our inclusion criteria. Stenting (risk ratio 0.57; 95% credible interval, 0.33-0.79) and decompressing stomas (risk ratio 0.46, 95% credible interval: 0.18-0.92) resulted in a significant reduction in the permanent stoma rate. Stenting facilitated minimally invasive surgery more frequently (risk ratio 4.10; 95% credible interval, 1.45-13.13) and had lower overall morbidity (risk ratio 0.58; 95% credible interval, 0.35-0.86). A pairwise analysis of primary anastomosis rates showed increased stenting (risk ratio 1.40; 95% credible interval, 1.31-1.49) compared with emergency resection. There was a significant decrease in the 90-day mortality with stenting (risk ratio 0.63; 95% credible interval, 0.41-0.95) compared with resection. There were no differences in disease-free and overall survival rates, respectively. LIMITATIONS There is a lack of randomized controlled trials and propensity score matching data comparing short-term and long-term outcomes for diverting stomas compared to self-expanding metallic stents. Two trials compared self-expanding metallic stents and diverting stomas in left-sided malignant colonic obstruction. CONCLUSIONS This study provides high-level evidence that a bridge-to-surgery strategy is safe for the management of left-sided malignant colonic obstruction and may facilitate minimally invasive surgery, increase primary anastomosis rates, and reduce permanent stoma rates and postoperative morbidity compared with emergency colonic resection.
Collapse
Affiliation(s)
- Fiachra T McHugh
- Department of Colorectal Surgery, Tallaght University Hospital, Tallaght, Dublin, Ireland
| | - Éanna J Ryan
- Department of Colorectal Surgery, Tallaght University Hospital, Tallaght, Dublin, Ireland
| | - Odhrán K Ryan
- Department of Colorectal Surgery, Tallaght University Hospital, Tallaght, Dublin, Ireland
| | - Jonavan Tan
- Department of Colorectal Surgery, Tallaght University Hospital, Tallaght, Dublin, Ireland
| | - Patrick A Boland
- Department of Colorectal Surgery, Tallaght University Hospital, Tallaght, Dublin, Ireland
| | - Maria C Whelan
- Department of Colorectal Surgery, Tallaght University Hospital, Tallaght, Dublin, Ireland
- Trinity College Dublin, College Green, Dublin, Ireland
| | - Michael E Kelly
- Department of Colorectal Surgery, Tallaght University Hospital, Tallaght, Dublin, Ireland
- Trinity College Dublin, College Green, Dublin, Ireland
| | - Deirdre McNamara
- Department of Gastroenterology, Tallaght University Hospital, Tallaght, Dublin, Ireland
- Trinity College Dublin, College Green, Dublin, Ireland
| | - Paul C Neary
- Department of Colorectal Surgery, Tallaght University Hospital, Tallaght, Dublin, Ireland
- Trinity College Dublin, College Green, Dublin, Ireland
| | - James M O'Riordan
- Department of Colorectal Surgery, Tallaght University Hospital, Tallaght, Dublin, Ireland
- Trinity College Dublin, College Green, Dublin, Ireland
| | - Dara O Kavanagh
- Department of Colorectal Surgery, Tallaght University Hospital, Tallaght, Dublin, Ireland
- Department of Surgical Affairs, Royal College of Surgeons Ireland, Dublin, Ireland
| |
Collapse
|
|
5
|
Lin W, Chok AY, Seow-En I, Tan EKW. Stenting as bridge to surgery versus upfront emergency resection for non-metastatic left sided obstructing colorectal cancer: risk of peritoneal recurrence and long-term outcomes. Surg Endosc 2024; 38:2632-2640. [PMID: 38503904 DOI: 10.1007/s00464-024-10780-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 03/04/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Oncological outcomes of stenting as a bridge to surgery (SBTS) remain a major concern, despite perioperative benefits it offers. This study aims to evaluate the differences in recurrence patterns and survival in patients with non-metastatic, obstructing left sided colon cancers treated by SBTS versus upfront emergency surgery (ES). METHODS This is a retrospective, single-centre cohort study of 227 consecutive patients with non-metastatic, obstructing left sided colon cancer between 2007 and 2016. Primary outcomes were pattern of recurrence, and survival. Univariate, bivariate and multivariate logistic regression were done to determine relationships between factors and recurrence. Kaplan Meier curves and log rank tests were used to analyse survival outcomes. RESULTS Of the 227 patients included, 62 underwent SBTS and 165 underwent upfront ES. There was a higher rate of peritoneal recurrence in SBTS group (27.4 vs 15.2% p = 0.034), with no difference observed in overall, liver or lung recurrences. No significant difference in overall survival (p = 0.11), cancer specific survival (p = 0.35), or recurrence free survival (p = 0.107) was observed. Univariate analysis showed that SBTS (OR 2.12, p = 0.036), diabetes mellitus (DM) (OR 2.58, p = 0.013), T4 (OR 2.81, p = 0.001), N + (OR 4.02, p = 0.001), lymphovascular invasion (OR 2.43, p = 0.011) contributed to a higher rate of peritoneal recurrence. Bivariate analysis showed synergistic relationship between T4 tumors and SBTS: in T4 tumors that underwent SBTS, the odds of having peritoneal recurrence was 6.8 times higher when compared to ES (p = 0.004); whilst in T2/3 tumors there was no significant difference observed (OR 1.33, p = 0.55). Multivariable analysis showed SBTS (OR 2.60, p = 0.04), DM (OR 2.88, p = 0.012), N + (OR 2.97, p = 0.026) were significant predictors for peritoneal recurrence. CONCLUSIONS There are concerns over oncological safety of SBTS even with low rates of stent-related perforation. Higher rates of peritoneal recurrence are seen especially with T4 colon cancers treated with SBTS. SBTS, DM and nodal stage were significant predictors for peritoneal recurrence.
Collapse
Affiliation(s)
- Wenjie Lin
- Department of Colorectal Surgery, Singapore General Hospital, Academia, 20 College Road, Singapore, 169856, Singapore.
| | - Aik Yong Chok
- Department of Colorectal Surgery, Singapore General Hospital, Academia, 20 College Road, Singapore, 169856, Singapore
| | - Isaac Seow-En
- Department of Colorectal Surgery, Singapore General Hospital, Academia, 20 College Road, Singapore, 169856, Singapore
| | - Emile Kwong-Wei Tan
- Department of Colorectal Surgery, Singapore General Hospital, Academia, 20 College Road, Singapore, 169856, Singapore
| |
Collapse
|
|
6
|
Ryu HS, Kim HJ, Ji WB, Kim BC, Kim JH, Moon SK, Kang SI, Kwak HD, Kim ES, Kim CH, Kim TH, Noh GT, Park BS, Park HM, Bae JM, Bae JH, Seo NE, Song CH, Ahn MS, Eo JS, Yoon YC, Yoon JK, Lee KH, Lee KH, Lee KY, Lee MS, Lee SH, Lee JM, Lee JE, Lee HH, Ihn MH, Jang JH, Jeon SK, Chae KJ, Choi JH, Pyo DH, Ha GW, Han KS, Hong YK, Hong CW, Kwak JM. Colon cancer: the 2023 Korean clinical practice guidelines for diagnosis and treatment. Ann Coloproctol 2024; 40:89-113. [PMID: 38712437 PMCID: PMC11082542 DOI: 10.3393/ac.2024.00059.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 03/11/2024] [Accepted: 03/18/2024] [Indexed: 05/08/2024] Open
Abstract
Colorectal cancer is the third most common cancer in Korea and the third leading cause of death from cancer. Treatment outcomes for colon cancer are steadily improving due to national health screening programs with advances in diagnostic methods, surgical techniques, and therapeutic agents.. The Korea Colon Cancer Multidisciplinary (KCCM) Committee intends to provide professionals who treat colon cancer with the most up-to-date, evidence-based practice guidelines to improve outcomes and help them make decisions that reflect their patients' values and preferences. These guidelines have been established by consensus reached by the KCCM Guideline Committee based on a systematic literature review and evidence synthesis and by considering the national health insurance system in real clinical practice settings. Each recommendation is presented with a recommendation strength and level of evidence based on the consensus of the committee.
Collapse
Affiliation(s)
- Hyo Seon Ryu
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Hyun Jung Kim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
- Institute for Evidence-based Medicine, Cochrane Collaboration, Seoul, Korea
| | - Woong Bae Ji
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Ansan Hospital, Ansan, Korea
| | - Byung Chang Kim
- Center for Colorectal Cancer, National Cancer Center, Goyang, Korea
| | - Ji Hun Kim
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Kyung Moon
- Department of Radiology, Kyung Hee University Hospital, Seoul, Korea
| | - Sung Il Kang
- Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Han Deok Kwak
- Department of Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Eun Sun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Chang Hyun Kim
- Department of Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Tae Hyung Kim
- Department of Radiation Oncology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Gyoung Tae Noh
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Byung-Soo Park
- Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Hyeung-Min Park
- Department of Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Jeong Mo Bae
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Jung Hoon Bae
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ni Eun Seo
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Hoon Song
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Mi Sun Ahn
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Jae Seon Eo
- Department of Nuclear Medicine and Molecular Imaging, Korea University College of Medicine, Seoul, Korea
| | - Young Chul Yoon
- Department of General Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon-Kee Yoon
- Department of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, Suwon, Korea
| | - Kyung Ha Lee
- Department of Surgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Kyung Hee Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kil-Yong Lee
- Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Myung Su Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Sung Hak Lee
- Department of Hospital Pathology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong Min Lee
- Department of Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Ji Eun Lee
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Han Hee Lee
- Division of Gastroenterology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myong Hoon Ihn
- Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Je-Ho Jang
- Department of Surgery, Daejeon Eulji Medical Center, Eulji University, Daejeon, Korea
| | - Sun Kyung Jeon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Kum Ju Chae
- Department of Radiology, Jeonbuk National University Medical School, Jeonju, Korea
| | - Jin-Ho Choi
- Center for Lung Cancer, Department of Thoracic Surgery, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Dae Hee Pyo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gi Won Ha
- Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Kyung Su Han
- Center for Colorectal Cancer, National Cancer Center, Goyang, Korea
| | - Young Ki Hong
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Chang Won Hong
- Center for Colorectal Cancer, National Cancer Center, Goyang, Korea
| | - Jung-Myun Kwak
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Korean Colon Cancer Multidisciplinary Committee
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
- Institute for Evidence-based Medicine, Cochrane Collaboration, Seoul, Korea
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Ansan Hospital, Ansan, Korea
- Center for Colorectal Cancer, National Cancer Center, Goyang, Korea
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Radiology, Kyung Hee University Hospital, Seoul, Korea
- Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea
- Department of Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
- Department of Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
- Department of Radiation Oncology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
- Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea
- Department of Nuclear Medicine and Molecular Imaging, Korea University College of Medicine, Seoul, Korea
- Department of General Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, Suwon, Korea
- Department of Surgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Hospital Pathology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
- Division of Gastroenterology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Surgery, Daejeon Eulji Medical Center, Eulji University, Daejeon, Korea
- Department of Radiology, Jeonbuk National University Medical School, Jeonju, Korea
- Center for Lung Cancer, Department of Thoracic Surgery, Research Institute and Hospital, National Cancer Center, Goyang, Korea
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| |
Collapse
|
|
7
|
Giordano A, Podda M, Montori G, Botteri E, Fugazzola P, Ortenzi M, Guerrieri M, Vettoretto N, Agresta F, Sartori A, Bergamini C, Martellucci J, Guariniello A, Fransvea P, Azzinnaro A, Scatizzi M, Catena F, Coccolini F, Ansaloni L, Sartelli M, Sapienza P, Mingoli A, Prosperi P. Colonic Resection, Stoma, or Self-expanding Metal Stents for Obstructive Left Colon Cancer: the CROSCO-1 study protocol. Minerva Surg 2024; 79:7-14. [PMID: 37705392 DOI: 10.23736/s2724-5691.23.09969-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is one of the most common cancers worldwide. There are several causes of a mechanical left bowel obstructive but CRC accounts for approximately 50% of cases and in 10-30% of whom it is the presenting syndrome. In most cases, the left colon is involved. At present, the range of therapeutic alternatives in the management of obstructive left CRC in emergency conditions (primary resection vs. staged resection with applied self-expanding metallic stents) is broad, whereas internationally validated clinical recommendations in each condition are still lacking. This enormous variability affects the scientific evidence on both the immediate and long-term surgical and oncological outcomes. METHODS CROSCO-1 (Colonic Resection, Stoma or Self-expanding Metal Stents for Obstructive Left Colon Cancer) study is a national, multi-center, prospective observational study intending to compare the clinical results of all these therapeutic regimens in a cohort of patients treated for obstructive left-sided CRC. RESULTS The primary aim of the CROSCO-1 study is the 1-year stoma rate of patients undergoing primary emergency surgical resection (Hartmann procedure or primary resection and anastomosis) compared with patients undergoing staged resection. Secondary outcomes are 30-day and 90-day major morbidity and mortality, 1-year quality of life and the timing of chemotherapy initiation in the two groups. Future CROSCO studies will follow in which, instead, we will evaluate the long-term oncological outcomes of the two treatment strategies. CONCLUSIONS The results of a large prospective cohort study which will analyze what really happens in the common clinical practice of managing patients with obstructive left CRC will have the aim of understanding which is the best strategy in terms of surgical and oncological outcomes. Indeed, the CROSCO-1 study will analyze the early surgical outcomes for patients with obstructed left CRC. Future CROSCO studies will follow in which, instead, we will evaluate the long-term oncological outcomes of the two treatment strategies.
Collapse
Affiliation(s)
- Alessio Giordano
- Emergency Surgery Unit, Emergency Department, Careggi University Hospital, Florence, Italy -
| | - Mauro Podda
- General Surgery Unit, Department of Surgery, University Hospital of Cagliari, Cagliari, Italy
| | - Giulia Montori
- Department of General Surgery, ULSS2 Marca Trevigiana, Vittorio Veneto, Treviso, Italy
| | - Emanuele Botteri
- General Surgery Unit, ASST Spedali Civili, Montichiari, Brescia, Italy
| | - Paola Fugazzola
- Division of General Surgery, IRCCS San Matteo Polyclinic Foundation, Pavia, Italy
| | - Monica Ortenzi
- Department of General Surgery, Polytechnical University of Marche, Ancona, Italy
| | - Mario Guerrieri
- Department of General Surgery, Polytechnical University of Marche, Ancona, Italy
| | - Nereo Vettoretto
- General Surgery Unit, ASST Spedali Civili, Montichiari, Brescia, Italy
| | - Ferdinando Agresta
- Department of General Surgery, ULSS2 Marca Trevigiana, Vittorio Veneto, Treviso, Italy
| | - Alberto Sartori
- Department of General Surgery, Montebelluna Hospital, Montebelluna, Treviso, Italy
| | - Carlo Bergamini
- Emergency Surgery Unit, Emergency Department, Careggi University Hospital, Florence, Italy
| | - Jacopo Martellucci
- Emergency Surgery Unit, Emergency Department, Careggi University Hospital, Florence, Italy
| | - Anna Guariniello
- Emergency Surgery Unit, Department of Surgery, S. Maria delle Croci Hospital, Ravenna, Italy
| | - Pietro Fransvea
- Emergency Surgery and Trauma Department, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | | | - Marco Scatizzi
- General Surgery Unit, Department of Surgery, Santa Maria Annunziata and Serristori Hospital, Florence, Italy
| | - Fausto Catena
- Department of General and Emergency Surgery, Bufalini Hospital, Cesena, Italy
| | - Federico Coccolini
- Department of Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Luca Ansaloni
- Division of General Surgery, IRCCS San Matteo Polyclinic Foundation, Pavia, Italy
| | - Massimo Sartelli
- General Surgery Unit, Department of Surgery, Macerata Hospital, Macerata, Italy
| | - Paolo Sapienza
- Emergency Department, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Andrea Mingoli
- Emergency Department, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Paolo Prosperi
- Emergency Surgery Unit, Emergency Department, Careggi University Hospital, Florence, Italy
| |
Collapse
|
|
8
|
Shang R, Han X, Zeng C, Lv F, Fang R, Tian X, Ding X. Colonic stent as a bridge to surgery versus emergency rection for malignant left-sided colorectal obstruction: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2023; 102:e36078. [PMID: 38115371 PMCID: PMC10727616 DOI: 10.1097/md.0000000000036078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/05/2023] [Accepted: 10/20/2023] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION The role of self-expanding metal stent (SEMS) implantation as a bridge to surgery in malignant left-sided colorectal obstruction (MLCO) remains controversial. OBJECTIVE To evaluate the safety of SEMS implantation versus emergency surgery (ER) in the treatment of MLCO. METHODS Four major literature databases (Cochrane Library, Embase, PubMed, and Web of Science) were searched to collect articles published before April 20, 2023. After determining random or fixed-effect models based on heterogeneity tests, odds ratios (RR) or standardized mean differences (SMD) with their respective 95% confidence intervals (CI) were calculated. RESULTS Nineteen randomized controlled studies were included. The main outcomes included overall tumor recurrence rate, 30-day mortality rate, and overall incidence of complications. Secondary outcomes included mortality-related indicators, tumor recurrence-related indicators, surgery-related indicators, and other relevant indicators. The study found that there was no significant difference in the 30-day mortality rate between the SEMS group and the er group. However, the SEMS group had a lower overall incidence of complications (RR = 0.787, P = .004), lower incision infection rate (RR = 0.472, P = .003), shorter operation time (SMD = -0.591, P = .000), lower intraoperative blood loss (SMD = -1.046, P = .000), lower intraoperative transfusion rate (RR = 0.624, P = .021), lower permanent stoma rate (RR = 0.499, P = .000), lower overall stoma rate (RR = 0.520,P = .000), shorter hospital stay (SMD = -0.643, P = .014), and more lymph node dissections during surgery (SMD = 0.222, 95% CI: 0.021-0.423, P = .031), as well as a higher primary anastomosis rate (RR = 0.472, 95% CI: 0.286-0.7 77, P = .003), among other advantages. However, the SEMS group had a higher overall tumor recurrence rate (RR = 1.339, P = .048). CONCLUSION SEMS has significant advantages over er in relieving clinical symptoms and facilitating postoperative recovery in MLCO, but does not reduce the tumor recurrence rate. Neoadjuvant chemotherapy combined with SEMS may provide a new approach to the treatment of MLCO.
Collapse
Affiliation(s)
- Rumin Shang
- Department of Gastroenterology, Wuhan Pu’ai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Gastroenterology, Wuhan Fourth Hospital, Wuhan, China
| | - Xiangming Han
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Cui Zeng
- Department of Gastroenterology, Wuhan Fourth Hospital, Wuhan, China
| | - Fei Lv
- Department of Gastroenterology, Wuhan Fourth Hospital, Wuhan, China
| | - Rong Fang
- Department of Gastroenterology, Wuhan Fourth Hospital, Wuhan, China
| | - Xiaochang Tian
- Department of Gastroenterology, Wuhan Fourth Hospital, Wuhan, China
| | - Xiangwu Ding
- Department of Gastroenterology, Wuhan Fourth Hospital, Wuhan, China
| |
Collapse
|
|
9
|
Boeding JRE, Elferink MAG, Tanis PJ, de Wilt JHW, Gobardhan PD, Verhoef C, Schreinemakers JMJ. Surgical treatment and overall survival in patients with right-sided obstructing colon cancer-a nationwide retrospective cohort study. Int J Colorectal Dis 2023; 38:248. [PMID: 37796315 PMCID: PMC10556181 DOI: 10.1007/s00384-023-04541-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/06/2023]
Abstract
PURPOSE The aim of this study was to compare baseline characteristics, 90-day mortality and overall survival (OS) between patients with obstructing and non-obstructing right-sided colon cancer at a national level. METHODS All patients who underwent resection for right-sided colon cancer between January 2015 and December 2016 were selected from the Netherlands Cancer Registry and stratified for obstruction. Primary outcome was 5-year OS after excluding 90-day mortality as assessed by the Kaplan-Meier and multivariable Cox regression analysis. RESULTS A total of 525 patients (7%) with obstructing and 6891 patients (93%) with non-obstructing right-sided colon cancer were included. Patients with right-sided obstructing colon cancer (OCC) were older and had more often transverse tumour location, and the pathological T and N stage was more advanced than in those without obstruction (p < 0.001). The 90-day mortality in patients with right-sided OCC was higher compared to that in patients with non-obstructing colon cancer: 10% versus 3%, respectively (p < 0.001). The 5-year OS of those surviving 90 days postoperatively was 42% in patients with OCC versus 73% in patients with non-obstructing colon cancer, respectively (p < 0.001). Worse 5-year OS was found in patients with right-sided OCC for all stages. Obstruction was an independent risk factor for decreased OS in right-sided colon cancer (HR 1.79, 95% CI 1.57-2.03). CONCLUSION In addition to increased risk of postoperative mortality, a stage-independent worse 5-year OS after excluding 90-day mortality was found in patients with right-sided OCC compared to patients without obstruction.
Collapse
Affiliation(s)
- Jeske R E Boeding
- Department of Surgery, Amphia Hospital, Breda, The Netherlands.
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - Marloes A G Elferink
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Pieter J Tanis
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | |
Collapse
|
|
10
|
Li JW, Ngu JCY, Lim KR, Tay SW, Jiang B, Wijaya R, Yusof S, Ong CJ, Kwek ABE, Ang TL. Colonic stenting in acute malignant large bowel obstruction: audit of efficacy and safety in a Singapore tertiary referral centre. Singapore Med J 2023; 64:603-608. [PMID: 34600451 PMCID: PMC10645007 DOI: 10.11622/smedj.2021127] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 01/30/2021] [Indexed: 01/10/2023]
Abstract
Introduction Acute malignant large bowel obstruction (MBO) occurs in 8%-15% of colorectal cancer patients. Self-expandable metal stents (SEMS) have progressed from a palliative modality to use as bridge to surgery (BTS). We aimed to assess the safety and efficacy of SEMS for MBO in our institution. Methods The data of patients undergoing SEMS insertion for MBO were reviewed. Technical success was defined as successful SEMS deployment across tumour without complications. Clinical success was defined as colonic decompression without requiring further surgical intervention. Rates of complications, median time to surgery, types of surgery and rates of recurrence were studied. Results Seventy-nine patients underwent emergent SEMS placement from September 2013 to February 2020. Their mean age was 68.8 ± 13.8 years and 43 (54%) patients were male. Mean tumour length was 4.2 cm ± 2.2 cm; 89.9% of malignant strictures were located distal to the splenic flexure. Technical and clinical success was 94.9% and 98.7%, respectively. Perforation occurred in 5.1% of patients, with none having stent migration or bleeding. Fifty (63.3%) patients underwent SEMS insertion as BTS. Median time to surgery was 20 (range 6-57) days. Most (82%) patients underwent minimally invasive surgery. Primary anastomosis rate was 98%. Thirty-nine patients had follow-up beyond 1-year posttreatment (median 34 months). Local recurrence and distant metastasis were observed in 4 (10.3%) and 5 (12.8%) patients, respectively. Conclusion Insertion of SEMS for acute MBO has high success rates and a good safety profile. Most patients in this audit underwent minimally invasive surgery and primary anastomosis after successful BTS.
Collapse
Affiliation(s)
- James Weiquan Li
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore Health Services, Singapore
| | - James Chi-Yong Ngu
- Department of General Surgery, Changi General Hospital, Singapore Health Services, Singapore
| | - Kok Ren Lim
- Department of General Surgery, Changi General Hospital, Singapore Health Services, Singapore
| | - Shu Wen Tay
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore Health Services, Singapore
| | - Bochao Jiang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore Health Services, Singapore
| | - Ramesh Wijaya
- Department of General Surgery, Changi General Hospital, Singapore Health Services, Singapore
| | - Sulaiman Yusof
- Department of General Surgery, Changi General Hospital, Singapore Health Services, Singapore
| | - Calvin Jianming Ong
- Department of General Surgery, Changi General Hospital, Singapore Health Services, Singapore
| | - Andrew Boon Eu Kwek
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore Health Services, Singapore
| | - Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore Health Services, Singapore
| |
Collapse
|
|
11
|
Ma W, Zhang JC, Luo K, Wang L, Zhang C, Cai B, Jiang H. Self-expanding metal stents versus decompression tubes as a bridge to surgery for patients with obstruction caused by colorectal cancer: a systematic review and meta-analysis. World J Emerg Surg 2023; 18:46. [PMID: 37759264 PMCID: PMC10536785 DOI: 10.1186/s13017-023-00515-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Using self-expanding metal stents (SEMS) and decompression tubes (DT) as a bridge-to-surgery (BTS) treatment may avoid emergency operations for patients with colorectal cancer-caused obstructions. This study aimed to evaluate the efficacy and safety of the two approaches. METHODS We systematically retrieved literature from January 1, 2000, to May 30, 2023, from the PubMed, Embase, Web of Science, SinoMed, Wanfang Data, Chinese National Knowledge Infrastructure, and Cochrane Central Register of Clinical Trials databases. Randomized controlled trials (RCTs) or cohort studies of SEMS versus DT as BTS in colorectal cancer obstruction were selected. Risks of bias were assessed for RCTs and cohort studies using the Cochrane Risk of Bias tool version 2 and Risk of Bias in Nonrandomized Studies of Interventions. Certainty of evidence was determined using the Graded Recommendation Assessment. Odds ratio (OR), mean difference (MD), and 95% confidence interval (95% CI) were used to analyze measurement data. RESULTS We included eight RCTs and eighteen cohort studies involving 2,061 patients (SEMS, 1,044; DT, 1,017). Pooled RCT and cohort data indicated the SEMS group had a significantly higher clinical success rate than the DT group (OR = 1.99, 95% CI 1.04, 3.81, P = 0.04), but no significant difference regarding technical success (OR = 1.29, 95% CI 0.56, 2.96, P = 0.55). SEMS had a shorter postoperative length of hospital stays (MD = - 4.47, 95% CI - 6.26, - 2.69, P < 0.00001), a lower rates of operation-related abdominal pain (OR = 0.16, 95% CI 0.05, 0.50, P = 0.002), intraoperative bleeding (MD = - 37.67, 95% CI - 62.73, - 12.60, P = 0.003), stoma creation (OR = 0.41, 95% CI 0.23, 0.73, P = 0.002) and long-term tumor recurrence rate than DT (OR = 0.47, 95% CI 0.22, 0.99, P = 0.05). CONCLUSION SEMS and DT are both safe as BTS to avoid emergency surgery for patients with colorectal cancer obstruction. SEMS is preferable because of higher clinical success rates, lower rates of operation-related abdominal pain, intraoperative bleeding, stoma creation, and long-term tumor recurrence, as well as a shorter postoperative length of hospital stays. Trial registration CRD42022365951 .
Collapse
Affiliation(s)
- Wei Ma
- School of Medicine and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
| | - Jian-Cheng Zhang
- Institute for Emergency and Disaster Medicine, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan Province, No. 32, Yi Huan Lu Xi Er Duan, Chengdu, 610072, China
- Sichuan Provincial Center for Emergency Medicine, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China
- Sichuan Provincial Research Center for Emergency Medicine and Critical Illness. Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Kun Luo
- School of Medicine and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
| | - Lu Wang
- Institute for Emergency and Disaster Medicine, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan Province, No. 32, Yi Huan Lu Xi Er Duan, Chengdu, 610072, China
- Sichuan Provincial Center for Emergency Medicine, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China
- Sichuan Provincial Research Center for Emergency Medicine and Critical Illness. Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Chi Zhang
- Institute for Emergency and Disaster Medicine, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan Province, No. 32, Yi Huan Lu Xi Er Duan, Chengdu, 610072, China
- Sichuan Provincial Center for Emergency Medicine, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China
- Sichuan Provincial Research Center for Emergency Medicine and Critical Illness. Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Bin Cai
- Institute for Emergency and Disaster Medicine, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan Province, No. 32, Yi Huan Lu Xi Er Duan, Chengdu, 610072, China.
- Sichuan Provincial Center for Emergency Medicine, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China.
- Sichuan Provincial Research Center for Emergency Medicine and Critical Illness. Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China.
| | - Hua Jiang
- Institute for Emergency and Disaster Medicine, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan Province, No. 32, Yi Huan Lu Xi Er Duan, Chengdu, 610072, China.
- Sichuan Provincial Center for Emergency Medicine, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China.
- Sichuan Provincial Research Center for Emergency Medicine and Critical Illness. Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China.
| |
Collapse
|
|
12
|
Boeding JRE, Cuperus IE, Rijken AM, Crolla RMPH, Verhoef C, Gobardhan PD, Schreinemakers JMJ. Postponing surgery to optimise patients with acute right-sided obstructing colon cancer - A pilot study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106906. [PMID: 37061403 DOI: 10.1016/j.ejso.2023.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 04/01/2023] [Accepted: 04/06/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND Right-sided obstructing colon cancer is most often treated with acute resection. Recent studies on right-sided obstructing colon cancer report higher mortality and morbidity rates than those in patients without obstruction. The aim of this study is to retrospectively analyse whether it is possible to optimise the health condition of patients with acute right-sided obstructing colon cancer, prior to surgery, and whether this improves postoperative outcomes. METHOD All consecutive patients with high suspicion of, or histologically proven, right-sided obstructing colon cancer, treated with curative intent between March 2013 and December 2019, were analysed retrospectively. Patients were divided into two groups: optimised group and non-optimised group. Pre-operative optimisation included additional nutrition, physiotherapy, and, if needed, bowel decompression. RESULTS In total, 54 patients were analysed in this study. Twenty-four patients received optimisation before elective surgery, and thirty patients received emergency surgery, without optimisation. Scheduled surgery was performed after a median of eight days (IQR 7-12). Postoperative complications were found in twelve (50%) patients in the optimised group, compared to twenty-three (77%) patients in the non-optimised group (p = 0.051). Major complications were diagnosed in three (13%) patients with optimisation, compared to ten (33%) patients without optimisation (p = 0.111). Postoperative in-hospital stay, 30-day mortality, as well as primary anastomosis were comparable in both groups. CONCLUSION This pilot study suggests that pre-operative optimisation of patients with obstructing right sided colonic cancer may be feasible and safe but is associated with longer in-patient stay.
Collapse
Affiliation(s)
- Jeske R E Boeding
- Department of Surgery, Amphia Hospital, Breda, the Netherlands; Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
| | - Iris E Cuperus
- Department of Surgery, Amphia Hospital, Breda, the Netherlands
| | - Arjen M Rijken
- Department of Surgery, Amphia Hospital, Breda, the Netherlands
| | | | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | | | | |
Collapse
|
|
13
|
McKechnie T, Springer JE, Cloutier Z, Archer V, Alavi K, Doumouras A, Hong D, Eskicioglu C. Management of left-sided malignant colorectal obstructions with curative intent: a network meta-analysis. Surg Endosc 2023; 37:4159-4178. [PMID: 36869265 PMCID: PMC9984133 DOI: 10.1007/s00464-023-09929-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 01/28/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Several management options exist for colonic decompression in the setting of malignant large bowel obstruction, including oncologic resection, surgical diversion, and SEMS as a bridge-to-surgery. Consensus has yet to be reached on optimal treatment pathways. The aim of the present study was to perform a network meta-analysis comparing short-term postoperative morbidity and long-term oncologic outcomes between oncologic resection, surgical diversion, and self-expanding metal stents (SEMS) in left-sided malignant colorectal obstruction with curative intent. METHODS Medline, Embase, and CENTRAL were systematically searched. Articles were included if they compared two or more of the following in patients presenting with curative left-sided malignant colorectal obstruction: (1) emergent oncologic resection; (2) surgical diversion; and/or (3) SEMS. The primary outcome was overall 90-day postoperative morbidity. Pairwise meta-analyses were performed with inverse variance random effects. Random-effect Bayesian network meta-analysis was performed. RESULTS From 1277 citations, 53 studies with 9493 patients undergoing urgent oncologic resection, 1273 patients undergoing surgical diversion, and 2548 patients undergoing SEMS were included. Network meta-analysis demonstrated a significant improvement in 90-day postoperative morbidity in patients undergoing SEMS compared to urgent oncologic resection (OR0.34, 95%CrI0.01-0.98). Insufficient RCT data pertaining to overall survival (OS) precluded network meta-analysis. Pairwise meta-analysis demonstrated decreased five-year OS for patients undergoing urgent oncologic resection compared to surgical diversion (OR0.44, 95%CI0.28-0.71, p < 0.01). CONCLUSIONS Bridge-to-surgery interventions may offer short- and long-term benefits compared to urgent oncologic resection for malignant colorectal obstruction and should be increasingly considered in this patient population. Further prospective study comparing surgical diversion and SEMS is needed.
Collapse
Affiliation(s)
- Tyler McKechnie
- Division of General Surgery, Department of Surgery, McMaster University, St. Joseph's Healthcare, 50 Charlton Avenue East Hamilton, Hamilton, ON, L8N 4A6, Canada
| | - Jeremy E Springer
- Division of Colon and Rectal Surgery, Department of Surgery, University of Massachusetts, Worcester, MA, USA
| | - Zacharie Cloutier
- Division of General Surgery, Department of Surgery, McMaster University, St. Joseph's Healthcare, 50 Charlton Avenue East Hamilton, Hamilton, ON, L8N 4A6, Canada
| | - Victoria Archer
- Division of General Surgery, Department of Surgery, McMaster University, St. Joseph's Healthcare, 50 Charlton Avenue East Hamilton, Hamilton, ON, L8N 4A6, Canada
| | - Karim Alavi
- Division of Colon and Rectal Surgery, Department of Surgery, University of Massachusetts, Worcester, MA, USA
| | - Aristithes Doumouras
- Division of General Surgery, Department of Surgery, McMaster University, St. Joseph's Healthcare, 50 Charlton Avenue East Hamilton, Hamilton, ON, L8N 4A6, Canada
- Division of General Surgery, Department of Surgery, St. Joseph Healthcare, Hamilton, ON, Canada
| | - Dennis Hong
- Division of General Surgery, Department of Surgery, McMaster University, St. Joseph's Healthcare, 50 Charlton Avenue East Hamilton, Hamilton, ON, L8N 4A6, Canada
- Division of General Surgery, Department of Surgery, St. Joseph Healthcare, Hamilton, ON, Canada
| | - Cagla Eskicioglu
- Division of General Surgery, Department of Surgery, McMaster University, St. Joseph's Healthcare, 50 Charlton Avenue East Hamilton, Hamilton, ON, L8N 4A6, Canada.
- Division of General Surgery, Department of Surgery, St. Joseph Healthcare, Hamilton, ON, Canada.
| |
Collapse
|
|
14
|
Paniagua García-Señoráns M, Sánchez Santos R, Cano Valderrama Ó, Vigorita V, de Castro Parga ML, Cea Pereira S, Rodríguez Fernández L, Moncada Iribarren E. Stent as bridge to surgery decreases postoperative complications without worsening oncological outcomes: retrospective unicentric cohort study and stent placement protocol. Surg Endosc 2023:10.1007/s00464-023-10091-0. [PMID: 37198409 DOI: 10.1007/s00464-023-10091-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/19/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Even if the use of stent as bridge to surgery (BTS) for obstructive colon cancer was described long ago, there is still much controversy on their use. Patient recovery before surgery and colonic desobstruction are just some of the reasons to defend this management that can be found in several available articles. METHODS This is a single-center, retrospective cohort study, including patients with obstructive colon cancer treated between 2010 and 2020. The primary aim of this study is to compare medium-term oncological outcomes (overall survival, disease-free survival) between stent as BTS and ES groups. The secondary aims are to compare perioperative results (in terms of approach, morbidity and mortality, and rate of anastomosis/stomas) between both groups and, within the BTS group, analyze whether there are any factors that may influence oncological outcomes. RESULTS A total of 251 patients were included. Patients belonging to the BTS cohort presented a higher rate of laparoscopic approach, required less intensive care management, less reintervention, and less permanent stoma rate, when comparing with patients who underwent urgent surgery (US). There were not significant differences in terms of disease-free survival and overall survival between the two groups. Lymphovascular invasion negatively affected oncological results but was not related with stent placement. CONCLUSION The stent as a bridge to surgery is a good alternative to urgent surgery, which leads to a decrease in postoperative morbidity and mortality without significantly worsening oncological outcomes.
Collapse
Affiliation(s)
- Marta Paniagua García-Señoráns
- Colorrectal Surgery Unit, Álvaro Cunqueiro Hospital, Vigo, Spain.
- Hospital Álvaro Cunqueiro, Estrada de Clara Campoamor, 341, 36312, Vigo, Spain.
| | | | | | | | | | - Sonia Cea Pereira
- Interventional Radiology Service, Álvaro Cunqueiro Hospital, Vigo, Spain
| | | | | |
Collapse
|
|
15
|
Walayat S, Johannes AJ, Benson M, Nelsen E, Akhter A, Kennedy G, Soni A, Reichelderfer M, Pfau P, Gopal D. Outcomes of colon self–expandable metal stents for malignant vs benign indications at a tertiary care center and review of literature. World J Gastrointest Endosc 2023; 15:309-318. [PMID: 37138935 PMCID: PMC10150280 DOI: 10.4253/wjge.v15.i4.309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/09/2023] [Accepted: 04/04/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Endoscopic placement of a self-expandable metal stent (SEMS) is a minimally invasive treatment for use in malignant and benign colonic obstruction. However, their widespread use is still limited with a nationwide analysis showing only 5.4% of patients with colon obstruction undergoing stent placement. This underutilization could be due to perceived increase risk of complications with stent placement.
AIM To review long- and short-term clinical success of SEMS use for colonic obstruction at our center.
METHODS We retrospectively reviewed all the patients who underwent colonic SEMS placement over a eighteen year period (August 2004 through August 2022) at our academic center. Demographics including age, gender, indication (malignant and benign), technical success, clinical success, complications (perforation, stent migration), mortality, and outcomes were recorded.
RESULTS Sixty three patients underwent colon SEMS over an 18-year period. Fifty-five cases were for malignant indications, 8 were for benign conditions. The benign strictures included diverticular disease stricturing (n = 4), fistula closure (n = 2), extrinsic fibroid compression (n = 1), and ischemic stricture (n = 1). Forty-three of the malignant cases were due to intrinsic obstruction from primary or recurrent colon cancer; 12 were from extrinsic compression. Fifty-four strictures occurred on the left side, 3 occurred on the right and the rest in transverse colon. The total malignant case (n = 55) procedural success rate was 95% vs 100% for benign cases (P = 1.0, NS). Overall complication rate was significantly higher for benign group: Four complications were observed in the malignant group (stent migration, restenosis) vs 2 of 8 (25%) for benign obstruction (1-perforation, 1-stent migration) (P = 0.02). When stratifying complications of perforation and stent migration there was no significant difference between the two groups (P = 0.14, NS).
CONCLUSION Colon SEMS remains a worthwhile option for colonic obstruction related to malignancy and has a high procedural and clinical success rate. Benign indications for SEMS placement appear to have similar success to malignant. While there appears to be a higher overall complication rate in benign cases, our study is limited by sample size. When evaluating for perforation alone there does not appear to be any significant difference between the two groups. SEMS placement may be a practical option for indications other that malignant obstruction. Interventional endoscopists should be aware and discuss the risk for complications in setting of benign conditions. Indications in these cases should be discussed in a multi-disciplinary fashion with colorectal surgery.
Collapse
Affiliation(s)
- Saqib Walayat
- Department of Gastroenterology, University of Wisconsin, Madison, WI 53705, United States
| | - Andrew J Johannes
- Department of Gastroenterology, University of Wisconsin, Madison, WI 53705, United States
| | - Mark Benson
- Department of Gastroenterology and Hepatology, University of Wisconsin, Madison, WI 53705, United States
| | - Eric Nelsen
- Gastroenterology, Park Nicollet Digestive and Endoscopy Center, Methodist Hospital, St. Louis Park, Minneapolis, MN 55426, United States
| | - Ahmed Akhter
- Department of Gastroenterology and Hepatology, University of Wisconsin, Madison, WI 53705, United States
| | - Gregory Kennedy
- Department of Surgery, University of Alabama-Birmingham School of Medicine, Brimingham, AL 35243, United States
| | - Anurag Soni
- Department of Gastroenterology and Hepatology, University of Wisconsin, Madison, WI 53705, United States
| | - Mark Reichelderfer
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, United States
| | - Patrick Pfau
- Department of Gastroenterology and Hepatology, University of Wisconsin, Madison, WI 53705, United States
| | - Deepak Gopal
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin Hospitals and Clinics, Madison, WI 53705, United States
| |
Collapse
|
|
16
|
Okuda Y, Shimura T, Uno K, Yamada T, Nukui T, Mizushima T, Takenaka Y, Itoh K, Inagaki Y, Ozeki T, Nagao K, Ebi M, Uchida E, Nomura S, Nojiri Y, Togawa S, Sugimura N, Fukusada S, Iwasaki H, Katano T, Kataoka H. A multicenter case-control study of self-expanding metallic stent versus trans-anal colorectal tube for stage II/III non-right-sided obstructive colon cancer. J Gastroenterol 2023; 58:217-228. [PMID: 36629947 DOI: 10.1007/s00535-022-01952-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/29/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Self-expanding metallic stent (SEMS) and trans-anal colorectal tube (TCT) are alternative treatments to conventional emergency surgery for non-right-sided obstructive colon cancer (NROCC). However, the one with better short- and long-term outcomes remains controversial. Thus, this multicenter case-control study aimed to analyze and compare SEMS and TCT for NROCC. METHODS Patients with stage II/III NROCC who underwent surgery between January 2010 and December 2019 at either of the eight selected Japanese affiliate hospitals were, retrospectively, reviewed. Baseline characteristics between the SEMS and TCT groups were adjusted by propensity score (PS) matching. RESULTS Among 239 reviewed patients (SEMS: 76, TCT: 163), 180 were finally included in two well-balanced cohorts through PS: SEMS group (65 patients) and TCT group (115 patients). Technical success, clinical success, morbidity, and short-term mortality were not significantly different between the two groups. SEMS placement achieved significantly higher rates for primary resection/anastomosis without stoma (SEMS: 90.8% vs. TCT: 77.4%, p < 0.001) and laparoscopic surgery (SEMS: 64.6% vs. TCT: 43.5%, p < 0.001) than TCT placement. However, 5-year overall survival (SEMS: 83.7% vs. TCT: 86.4%; p = 0.822) and 5-year relapse-free survival (SEMS: 64.7% vs. TCT: 66.4%; p = 0.854) showed no significant differences between these groups. CONCLUSIONS Both SEMS and TCT revealed similar long-term outcomes, but SEMS placement was better in achieving primary resection/anastomosis and laparoscopic surgery in patients with stage II/III NROCC.
Collapse
Affiliation(s)
- Yusuke Okuda
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, 467-8601, Japan
| | - Takaya Shimura
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, 467-8601, Japan.
| | - Konomu Uno
- Department of Gastroenterology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myoken-Cho, Showa-Ku, Nagoya, 466-8650, Japan
| | - Tomonori Yamada
- Department of Gastroenterology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myoken-Cho, Showa-Ku, Nagoya, 466-8650, Japan
| | - Takayuki Nukui
- Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, 5-161 Maehata, Tajimi, 507-8522, Japan
| | - Takashi Mizushima
- Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, 5-161 Maehata, Tajimi, 507-8522, Japan
| | - Yuya Takenaka
- Department of Gastroenterology, Nagoya City University East Medical Center, 1-2-23 Wakamizu, Chikusa-Ku, Nagoya, 464-8547, Japan
| | - Keisuke Itoh
- Department of Gastroenterology, Nagoya City University East Medical Center, 1-2-23 Wakamizu, Chikusa-Ku, Nagoya, 464-8547, Japan
| | - Yuki Inagaki
- Department of Gastroenterology, Toyokawa City Hospital, 23 Noji, Yahata, Toyokawa, 442-8561, Japan
| | - Takanori Ozeki
- Department of Gastroenterology, Toyokawa City Hospital, 23 Noji, Yahata, Toyokawa, 442-8561, Japan
| | - Kazuhiro Nagao
- Department of Gastroenterology, Aichi Medical University, 1-1 Karimata, Iwasaku, Nagakute, 480-1195, Japan
| | - Masahide Ebi
- Department of Gastroenterology, Aichi Medical University, 1-1 Karimata, Iwasaku, Nagakute, 480-1195, Japan
| | - Erika Uchida
- Department of Gastroenterology, Nagoya City University West Medical Center, 1-1-1 Hirate, Kita-Ku, Nagoya, 462-8508, Japan
| | - Satoshi Nomura
- Department of Gastroenterology, Nagoya City University West Medical Center, 1-1-1 Hirate, Kita-Ku, Nagoya, 462-8508, Japan
| | - Yu Nojiri
- Department of Gastroenterology, Nagoya Memorial Hospital, 4-305 Hirabari, Tenpaku-Ku, Nagoya, 468-8520, Japan
| | - Shozo Togawa
- Department of Gastroenterology, Nagoya Memorial Hospital, 4-305 Hirabari, Tenpaku-Ku, Nagoya, 468-8520, Japan
| | - Naomi Sugimura
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, 467-8601, Japan
| | - Shigeki Fukusada
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, 467-8601, Japan
| | - Hiroyasu Iwasaki
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, 467-8601, Japan
| | - Takahito Katano
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, 467-8601, Japan
| | - Hiromi Kataoka
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, 467-8601, Japan
| |
Collapse
|
|
17
|
Chok AY, Zhao Y, Lim HJ, Ng YYR, Tan EJKW. Stenting as a bridge to surgery in obstructing colon cancer: Long-term recurrence pattern and competing risk of mortality. World J Gastrointest Endosc 2023; 15:64-76. [PMID: 36925648 PMCID: PMC10011892 DOI: 10.4253/wjge.v15.i2.64] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/28/2022] [Accepted: 01/10/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Stenting as a bridge to curative surgery (SBTS) for obstructing colon cancer (OCC) has been associated with possibly worse oncological outcomes.
AIM To evaluate the recurrence patterns, survival outcomes, and colorectal cancer (CRC)-specific death in patients undergoing SBTS for OCC.
METHODS Data from 62 patients undergoing SBTS at a single tertiary centre over ten years between 2007 and 2016 were retrospectively examined. Primary outcomes were recurrence patterns, overall survival (OS), cancer-specific survival (CSS), and CRC-specific death. OS and CSS were estimated using the Kaplan-Meier curves. Competing risk analysis with cumulative incidence function (CIF) was used to estimate CRC-specific mortality with other cause-specific death as a competing event. Fine-Gray regressions were performed to determine prognostic factors of CRC-specific death. Univariate and multivariate subdistribution hazard ratios and their corresponding Wald test P values were calculated.
RESULTS 28 patients (45.2%) developed metastases after a median period of 16 mo. Among the 18 patients with single-site metastases: Four had lung-only metastases (14.3%), four had liver-only metastases (14.3%), and 10 had peritoneum-only metastases (35.7%), while 10 patients had two or more sites of metastatic disease (35.7%). The peritoneum was the most prevalent (60.7%) site of metastatic involvement (17/28). The median follow-up duration was 46 mo. 26 (41.9%) of the 62 patients died, of which 16 (61.5%) were CRC-specific deaths and 10 (38.5%) were deaths owing to other causes. The 1-, 3-, and 5-year OS probabilities were 88%, 74%, and 59%; 1-, 3-, and 5-year CSS probabilities were 97%, 83%, and 67%. The highest CIF for CRC-specific death at 60 mo was liver-only recurrence (0.69). Liver-only recurrence, peritoneum-only recurrence, and two or more recurrence sites were predictive of CRC-specific death.
CONCLUSION The peritoneum was the most common metastatic site among patients undergoing SBTS. Liver-only recurrence, peritoneum-only recurrence, and two or more recurrence sites were predictors of CRC-specific death.
Collapse
Affiliation(s)
- Aik Yong Chok
- Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | - Yun Zhao
- Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore
- Department of Group Analytics, Singapore Health Services, Singapore 168582, Singapore
| | - Hui Jun Lim
- Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | - Yvonne Ying Ru Ng
- Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | | |
Collapse
|
|
18
|
Khomvilai S, Pattarajierapan S. Comparison of long-term outcomes of colonic stenting as a "bridge to surgery" and emergency surgery in patients with left-sided malignant colonic obstruction. Ann Coloproctol 2023; 39:17-26. [PMID: 34324803 PMCID: PMC10009074 DOI: 10.3393/ac.2021.00227.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/20/2021] [Accepted: 05/26/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Long-term oncologic outcomes of colonic stenting as a "bridge to surgery" in patients with left-sided malignant colonic obstruction (LMCO) are unclear. This study was performed to compare long-term outcomes of self-expandable metal stent (SEMS) insertion as a bridge to surgery and emergency surgery in patients with acute LMCO. METHODS This retrospective cohort study included patients with acute LMCO who underwent SEMS insertion as a bridge to surgery or emergency surgery. The primary outcomes were 5-year disease-free survival (DFS), overall survival (OS), and recurrence rate. Survival outcomes were determined using the Kaplan-Meier method and compared using log-rank tests. RESULTS There was a trend of worsening 5-year OS rate in the SEMS group compared with emergency surgery group (45% vs. 57%, P=0.07). In stage-wise subgroup analyses, a trend of deteriorating 5-year OS rate in the SEMS group with stage III (43% vs. 59%, P=0.06) was observed. The 5-year DFS and recurrence rate were not different between groups. The overall median follow-up time was 58 months. On multivariate analysis, age of ≥65 years and American Joint Committee on Cancer stage of ≥III, and synchronous metastasis were significant poor prognostic factors for OS (hazard ratio [HR], 1.709; 95% confidence interval [CI], 1.007-2.900; P=0.05/HR, 1.988; 95% CI, 1.038-3.809; P=0.04/HR, 2.146; 95% CI, 1.191-3.866; P=0.01; respectively). CONCLUSION SEMS as a bridge to surgery may have adverse oncologic outcomes. Patients in the SEMS group had a trend of worsening 5-year OS rate without higher recurrence.
Collapse
Affiliation(s)
- Supakij Khomvilai
- Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sukit Pattarajierapan
- Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
|
19
|
A retrospective evaluation of short-term results from colonic stenting as a bridge to elective surgery versus emergency surgery for malignant colonic obstruction. Sci Rep 2023; 13:1600. [PMID: 36709359 PMCID: PMC9884234 DOI: 10.1038/s41598-023-28685-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/23/2023] [Indexed: 01/29/2023] Open
Abstract
The efficacy and safety of self-expanding metallic stent (SEMS) placement as a bridge to elective surgery versus emergency surgery to treat malignant colonic obstruction is debated. This study aimed to evaluate the outcomes of patients with malignant colonic obstruction treated using different procedure. Subjects admitted to the authors' department with colonic obstruction (n = 87) were studied. They underwent colonic stenting as a bridge to elective surgery (SEMS group: n = 14) or emergency surgery (ES group: n = 22).Their demographic characteristics, stoma rate, laparoscopy rate and postoperative complications were analyzed, and the potential risk factors of postoperative complications and the optimal time interval from SEMS implantation to elective surgery were explored. The stoma rate was 15.4% in the SEMS group versus 60.0% in the ES group (P = 0.015), and the postoperative complication rate was 7.7% in the SEMS group versus 40.0% in the ES group (P = 0.042). The proportion of patients undergoing laparoscopy in SEMS group was significantly higher than that in ES group (69.2% vs. 15.0%; P = 0.003).The effect of ASA grade on postoperative complications was statistically significant (OR = 24.565; P = 0.008). The Receiving operating characteristic (ROC) curve could not determine the optimal time interval between SEMS implantation and elective surgery (AUC = 0.466). SEMS implantation has the advantages of lower temporary stoma rate, less postoperative complications and higher laparoscopy rate compared with ES in the treatment of left malignant intestinal obstruction. ASA grade is a risk factor for postoperative complications. However, larger sample size prospective randomized controlled trials (RCT) are still needed to confirm long-term oncological outcomes.
Collapse
|
|
20
|
Arnarson Ö, Axmarker T, Syk I. Short- and long-term outcomes following bridge to surgery and emergency resection in acute malignant large bowel obstruction. Colorectal Dis 2022; 25:669-678. [PMID: 36567604 DOI: 10.1111/codi.16458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 11/07/2022] [Accepted: 11/29/2022] [Indexed: 12/27/2022]
Abstract
AIM Bridge to surgery (BtS) aims to decrease perioperative morbidity and mortality in emergency resection (ER) of the colon. Previous results are inconsistent, and long-term comparisons are scarce. The aim of this study was to compare the short- and long-term outcomes of BtS and ER. METHOD This retrospective study examined data from the Swedish Colorectal Cancer Registry for patients treated for acute malignant large bowel obstruction from 2007 to 2009. Patients were grouped by treatment strategy: BtS (using a self-expanding metallic stent or diverting stoma) or ER. Medical records were scrutinized for all patients in the BtS group. The primary endpoints were 5-year overall survival (OS) and 3-year recurrence-free survival (RFS). The secondary endpoints were postoperative mortality and morbidity rates and stoma permanence. RESULTS Overall, 143 patients were treated using BtS versus 1302 patients treated with ER. The 5-year OS was higher in the BtS group than in the ER group (53.8% vs. 37.4%; p < 0.05). No difference was noted in the 3-year RFS (75.7% vs. 75.0%; p = 0.38). The postoperative mortality rate was lower in the BtS group than in the ER group (0.7% vs. 7.3%; p < 0.05). Complications occurred in 46.9% of patients in the BtS group (both procedures) versus 35.9% of patients in the ER group (p < 0.05); the rate of severe complications was 23.1% and 16.9%, respectively (p = 0.07). CONCLUSION This retrospective population-based registry study showed higher long-term survival and lower postoperative mortality rates among patients treated with BtS versus ER for acute malignant large bowel obstruction.
Collapse
Affiliation(s)
- Örvar Arnarson
- Department of Surgery, Skane University Hospital Malmo, Lund University, Lund, Sweden
| | - Tobias Axmarker
- Department of Surgery, Skane University Hospital Malmo, Lund University, Lund, Sweden
| | - Ingvar Syk
- Lund University, Lund, Sweden.,Department of Surgery, Skane University Hospital, Malmo, Sweden
| |
Collapse
|
|
21
|
Pattarajierapan S, Sukphol N, Junmitsakul K, Khomvilai S. Oncologic safety of colonic stenting as a bridge to surgery in left-sided malignant colonic obstruction: Current evidence and prospects. World J Clin Oncol 2022; 13:943-956. [PMID: 36618077 PMCID: PMC9813833 DOI: 10.5306/wjco.v13.i12.943] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/10/2022] [Accepted: 12/08/2022] [Indexed: 12/19/2022] Open
Abstract
Approximately 7%-29% of patients with colorectal cancer present with colonic obstruction. The concept of self-expandable metal stent (SEMS) insertion as a bridge to surgery (BTS) is appealing. However, concerns on colonic stenting possibly impairing oncologic outcomes have been raised. This study aimed to review current evidence on the short- and long-term oncologic outcomes of SEMS insertion as BTS for left-sided malignant colonic obstruction. For short-term outcomes, colonic stenting facilitates a laparoscopic approach, increases the likelihood of primary anastomosis without a stoma, and may decrease postoperative morbidity. However, SEMS-related perforation also increases local recurrence and impairs overall survival. Moreover, colonic stenting may cause negative oncologic outcomes even without perforation. SEMS can induce shear forces on the tumor, leading to increased circulating cancer cells and aggressive pathological characteristics, including perineural and lymphovascular invasion. The conflicting evidence has led to discordant guidelines. Well-designed collaborative studies that integrate both oncologic outcomes and data on basic research (e.g., alteration of circulating tumors) are needed to clarify the actual benefit of colonic stenting as BTS.
Collapse
Affiliation(s)
- Sukit Pattarajierapan
- Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Nattapanee Sukphol
- Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Karuna Junmitsakul
- Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Supakij Khomvilai
- Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| |
Collapse
|
|
22
|
Hill J, Lee S, Morton D, Parker M, Halligan S, Taylor S, Kay C, Gray R, Handley K, Kaur M, Magill L, Fulcher L, Kaur M, Lilly H, Palmer A, Peters A, Magill L, Sidile C, Wilcockson A, Bensoussane H, Handley K, Marchevsky N, Oliver A, Carlson G, Scott N, Hiller L, Alderson D, Martin D, Yu L, Chokkalingam A, Cross N, Delicata RJ, Edwards P, Sturgeon G, Domingo D, Gutmann J, Huang J, Mills-Baldock T, Mtwana A, Premchand P, Willis N, Cocks S, Curran E, Gall Z, Harris P, Hobbiss J, Lipscomb G, Maxwell A, Patel H, Smith D, Antrum RM, Beckett CG, Davies J, Ghosh T, Gokhale J, Griffith JP, Halstead J, Jackson C, Jowett S, Kay C, Lowe A, May J, McGowan J, Robinson J, Simpson R, Stephenson S, Steward M, Thomas B, Thrower A, Ward K, Dexter J, Doyle T, Farrands P, Hart A, Lamah M, Peterson J, Brown H, Cameron E, Carroll N, Davies J, Fearnhead N, Goodwin K, Liddle A, Miller R, Morton J, Powar M, Read D, Sloan K, Uttridge J, Wheeler J, Bain I, Clark S, Cundall J, Dent J, Green S, Grunshaw N, Gunning K, Howey A, Marsden S, Minty I, et alHill J, Lee S, Morton D, Parker M, Halligan S, Taylor S, Kay C, Gray R, Handley K, Kaur M, Magill L, Fulcher L, Kaur M, Lilly H, Palmer A, Peters A, Magill L, Sidile C, Wilcockson A, Bensoussane H, Handley K, Marchevsky N, Oliver A, Carlson G, Scott N, Hiller L, Alderson D, Martin D, Yu L, Chokkalingam A, Cross N, Delicata RJ, Edwards P, Sturgeon G, Domingo D, Gutmann J, Huang J, Mills-Baldock T, Mtwana A, Premchand P, Willis N, Cocks S, Curran E, Gall Z, Harris P, Hobbiss J, Lipscomb G, Maxwell A, Patel H, Smith D, Antrum RM, Beckett CG, Davies J, Ghosh T, Gokhale J, Griffith JP, Halstead J, Jackson C, Jowett S, Kay C, Lowe A, May J, McGowan J, Robinson J, Simpson R, Stephenson S, Steward M, Thomas B, Thrower A, Ward K, Dexter J, Doyle T, Farrands P, Hart A, Lamah M, Peterson J, Brown H, Cameron E, Carroll N, Davies J, Fearnhead N, Goodwin K, Liddle A, Miller R, Morton J, Powar M, Read D, Sloan K, Uttridge J, Wheeler J, Bain I, Clark S, Cundall J, Dent J, Green S, Grunshaw N, Gunning K, Howey A, Marsden S, Minty I, Morgan L, Noblett S, Potts K, Scott J, Turnbull D, Varma JS, Wayman L, Welsh S, Anstead A, Bhardwaj R, Edmunds T, Fuller B, Holder P, Lacey L, Parker MC, Ryan R, Smith-Hedges J, Stuart C, Walsh K, Basu A, Omar A, Pitt J, Read G, Ridley P, Spurgeon J, Tricker Y, Bird N, Browell D, Barry C, Cunliffe W, Eltringham M, Katrory M, Mercer-Jones M, Nice C, Scott J, Timmons G, Williams M, Wipat C, Akula J, Caine A, Dawson P, Reese G, Fatola Y, Mazibuko B, Pelling M, Ramos L, Smith GV, Aryal K, Ashraf K, Badreldin R, Brett B, DeSilva A, Gray S, Harman J, Jordon M, Kshatriya KS, Lal R, Perry L, Velchuru V, Williams M, Chung-Faye G, Hansmann A, Leather A, Papagrigoriadis S, Peddu P, Ryan S, Ambrose S, Baker R, Beral D, Botterill I, Burke D, Clarke L, Evans M, Everett S, Finan PJ, Griffiths B, Hamlin J, Hance J, Harris K, Hussain M, Jayne D, Kelly S, Lim M, Maslekar S, Miskovic D, Moriarty C, Priestley M, Rawson S, Sagar PM, Saunders R, Sheridan M, Speight H, Tolan D, White L, Wilkinson L, Wilson T, Burling D, Clark S, Datt P, Fraser C, Gupta A, Jenkins I, Kennedy R, Northover JM, Sakuma S, Saunders BP, Suzuki N, Thomas-Gibson S, Curran F, Hitchen D, Immanuel A, Kirk S, Kushwaha R, Lee S, Parker M, Vanessa A, Butler-Barnes J, Hough C, Khan A, Larcombe T, London I, Selvasekar C, Zaman S, Anderson J, Ball J, Basheer M, Brittenden J, Fawole A, Foster R, Gill K, Hayton-Bott A, Jones A, Kamposioras K, Kerr S, Lowry T, Lupton S, Macklin C, Morrison C, Morrison CP, Narula H, Parchment-Smith C, Rogers M, Shah S, Sivakumar R, Sivaramakrishnan N, Vani D, Verma K, Sivanathan C, Chong P, Duff M, Duffey K, Horgan P, McGregor L, McKee R, Pender J, Viswanathan S, Ashcroft M, Docherty JG, Donaldson A, Lim M, Macleod K, Macleod AJM, Todd A, Walker KG, Watson AJM, Younger H, Brush J, Glancy S, MacRury M, Mander J, Paterson H, Atkin L, Brain C, Brunt S, Burt C, Cheshire H, Clout M, Corderoy H, Dawe C, Dixon AR, Garlicka H, Hopes M, John S, Kirby K, Kirkpatrick S, Law R, Longstaff A, Loveday E, Lyons A, McCarthy K, Pullyblank A, Reilly A, Richmond-Russell K, Roe AM, Saville L, Shelton L, Slack N, Smith C, Solomon L, Treasure A, Agarwal AK, Borowski D, Chilvers A, Dwarakanath D, Essex S, Garg D, Gill T, Jameson E, Jones-King P, Kiddell S, Latif H, Latimer J, Shepherd L, Sinclair S, Tabaqchali MA, Wardle H, Wilson D, Ahmad A, Arain A, Cartmell M, Cross K, Davis A, Groome J, Holbrook B, Ley S, Markham N, Menon M, Taylor J, Thomas F, Koutrik LV, Ahmad SM, Cursley V, Dent K, Martin K, Pai D, Pearson S, Abercrombie JF, Acheson A, Aldred L, Armitage NC, Banerjea A, Coulson C, Eyre M, Maxwell-Armstrong CA, O'Neil R, Ragunath K, Robinson MHE, Scholefield JH, Swinden R, Williams J, Anthony S, Bratby M, Cunningham C, Fourie S, Jones O, Lindsey I, Morrison F, Mortensen NJ, Munday D, Uberoi R, Ahmad F, Chandra N, Conaghan P, Coull D, Foxton J, Gibson M, Hameed W, Jones L, McGrath D, Ramus J, Samakomva T, Speirs A, Walsh K, Arumugam H, Ewiddison A, Faux W, Feldman M, Gopalswamy S, Graves L, Hancock J, Harvey P, Hussaini H, Lloyd-Davies E, Lynn C, Madine JP, Maskell G, Morley N, Pollard K, Prout K, Boorman P, Dickinson B, Guinness R, Hill T, Moran J, Anderson ID, Ashton A, Babbs C, Burnett H, Goulden K, Harrison P, Harter L, Hughes S, Kenyon V, Lee S, Lees N, Lydon A, Ogden A, Ottiwell L, Platt D, Read F, Slade D, Thompson C, Vinod C, Watson D, Brown S, Donnelly D, Hampton J, Eyre-Brook IA, Foot J, Forsyth N, Hunt L, Lowe A, Mackey P, Matull R, Thomas H, Vickery CJ, Caddy G, Foreman J, Hyland M, McCallion K, McFerran E, Tham T, Turkington J, Day S, Francombe J, Murphy P, Simmons E, Sinha R, Bull D, Compson A, Gould M, Ishaq S, Kawesha A, Maleki K, Marriott M, Poutney L, Stonelake PS, Adams C, Brundell S, Coleman M, Congdon H, Douie W, Eastlake L, Evenden L, Fox B, Gandy C, Georgiadis K, Hosie KB, Latchford A, Oppong FC, Pascoe J, Rance M, Shepherd E, Shirley J, Smith H, Appleton B, Bobary C, Feeney M, Gardner A, Krouma F, Richards D, Roche L, Tudor G, Young T, Olufunso A, Alderson D, Atif M, Bach S, Dasgin J, Forde C, Futaba K, Ghods-Ghorbani M, Gourevitch D, Ismail T, Keh C, Manimaran N, McCafferty I, Morton DG, Pandey S, Radley S, Riley P, Royle J, Suggett N, Torrance A, Tucker O, Vohra R, Aldous J, Beal D, Beveridge H, Bradshaw S, Carrick AJ, Coulson C, Dockree J, Fearon M, Hall A, Holding K, Hurst N, Irvine G, Langston K, Lund J, Redfern G, Reeves D, Reynolds JR, Rowntree J, Simmonds K, Singh R, Speake W, Tierney G, Tou S, Worth C, Singh B, Verma R, Allison J, Allison A, Bathurst N, Buckley C, Gotto J, Khan Z, Ockrim J, Rowland-Axe R, Russell A, Spurdle K, Williams-Yesson B, Ames A, Rylance PC, Dyer S, Fletcher J, Kent S, Law N, Macfie J, Mainprize K, Mallinson J, McNaught C, Mitchell C, Nunn A, Renwick IGH. Colorectal Endoscopic Stenting Trial (CReST) for obstructing left-sided colorectal cancer: randomized clinical trial. Br J Surg 2022; 109:1073-1080. [PMID: 35986684 DOI: 10.1093/bjs/znac141] [Show More Authors] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/13/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Colorectal cancer often presents with obstruction needing urgent, potentially life-saving decompression. The comparative efficacy and safety of endoluminal stenting versus emergency surgery as initial treatment for such patients is uncertain. METHODS Patients with left-sided colonic obstruction and radiological features of carcinoma were randomized to endoluminal stenting using a combined endoscopic/fluoroscopic technique followed by elective surgery 1-4 weeks later, or surgical decompression with or without tumour resection. Treatment allocation was via a central randomization service using a minimization procedure stratified by curative intent, primary tumour site, and severity score (Acute Physiology And Chronic Health Evaluation). Co-primary outcome measures were duration of hospital stay and 30-day mortality. Secondary outcomes were stoma formation, stenting completion and complication rates, perioperative morbidity, 6-month survival, 3-year recurrence, resource use, adherence to chemotherapy, and quality of life. Analyses were undertaken by intention to treat. RESULTS Between 23 April 2009 and 22 December 2014, 245 patients from 39 hospitals were randomized. Stenting was attempted in 119 of 123 allocated patients (96.7 per cent), achieving relief of obstruction in 98 of 119 (82.4 per cent). For the 89 per cent treated with curative intent, there were no significant differences in 30-day postoperative mortality (3.6 per cent (4 of 110) versus 5.6 per cent (6 of 107); P = 0.48), or duration of hospital stay (median 19 (i.q.r. 11-34) versus 18 (10-28) days; P = 0.94) between stenting followed by delayed elective surgery and emergency surgery. Among patients undergoing potentially curative treatment, stoma formation occurred less frequently in those allocated to stenting than those allocated to immediate surgery (47 of 99 (47.5 per cent) versus 72 of 106 (67.9 per cent); P = 0.003). There were no significant differences in perioperative morbidity, critical care use, quality of life, 3-year recurrence or mortality between treatment groups. CONCLUSION Stenting as a bridge to surgery reduces stoma formation without detrimental effects. Registration number: ISRCTN13846816 (http://www.controlled-trials.com).
Collapse
|
|
23
|
Hidalgo-Pujol M, Biondo S, Die Trill J, Vigorita V, Paniagua Garcia-Señorans M, Pascual Migueláñez I, Prieto-La Noire F, Timoteo A, Cornejo L, Martín Parra JI, Fidalgo García M, Solís-Peña A, Cirera de Tudela A, Rodriguez González A, Sánchez-Guillen L, Bustamante Recuenco C, Pérez-Alonso C, Hurtado Caballero E, Pascual M, García Septiem J, Mora López L, Cervera-Aldama J, Guadalajara H, Espín E, Kreisler E. Upfront surgery versus self-expanding metallic stent as bridge to surgery in left-sided colonic cancer obstruction: A multicenter observational study. Surgery 2022; 172:74-82. [PMID: 35168815 DOI: 10.1016/j.surg.2021.12.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 12/22/2021] [Accepted: 12/30/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Oncological outcomes of self-expanding metallic stent used as a bridge to surgery in potential curative patients with left-sided colonic cancer obstruction remain unclear. The aim of this study was to investigate perioperative and mid-term oncological outcomes of 2 of the currently most commonly performed treatments in left-sided colonic cancer obstruction. METHODS This is a retrospective multicenter study including patients with left-sided colonic cancer obstruction treated with curative intent between 2013 and 2017. The presence of metastasis at diagnosis was an exclusion criterion. The primary outcome was to evaluate the noninferiority, in terms of overall survival, of bridge to surgery strategy compared with emergency colonic resection. The secondary outcomes were perioperative morbimortality, disease free survival, local recurrence, and distant recurrence. RESULTS A total of 564 patients were included, 320 in the emergency colonic resection group and 244 in the bridge to surgery group. Twenty-seven patients of the bridge-to-surgery group needed urgent operation. Postoperative morbidity rates were statistically higher in the emergency colonic resection group (odds ratio [95% confidence interval] 0.37 [0.24-0.55], P < .001). There was no difference in 90-day mortality between groups (odds ratio [95% confidence interval] 0.85 [0.36-1.99], P = .702). The median follow-up was 3.80 years (2.29-4.92). The results show the noninferiority of bridge to surgery versus emergency colonic resection in terms of overall survival (hazard ratio [95% confidence interval) 0.78 [0.56-1.07], P = .127). There were no differences in disease free survival, distant recurrence, and local recurrence rates between bridge to surgery and emergency colonic resection groups. CONCLUSION Self-expanding metallic stent as bridge to surgery might not lead to a negative impact on the long-term prognosis of the tumor compared with emergency colonic resection in expert hands and selected patients.
Collapse
Affiliation(s)
- Marta Hidalgo-Pujol
- Department of General and Digestive Surgery, Coloproctology Unit, Bellvitge University Hospital, Barcelona, Spain; University of Barcelona and IBIDELL (Bellvitge Biomedical Investigation Institute), Barcelona, Spain.
| | - Sebastiano Biondo
- Department of General and Digestive Surgery, Coloproctology Unit, Bellvitge University Hospital, Barcelona, Spain; University of Barcelona and IBIDELL (Bellvitge Biomedical Investigation Institute), Barcelona, Spain
| | - Javier Die Trill
- Department of General and Digestive Surgery, Coloproctology Unit, Ramón y Cajal University Hospital, Madrid, Spain
| | - Vincenzo Vigorita
- Division of Coloproctology, Department of General and Digestive Surgery, University Hospital Complex of Vigo, Vigo, Spain; General Surgery Research Group, SERGAS-UVIGO, Galicia Sur Health Research Institute (IIS Galicia Sur), Vigo, Spain
| | - Marta Paniagua Garcia-Señorans
- Division of Coloproctology, Department of General and Digestive Surgery, University Hospital Complex of Vigo, Vigo, Spain; General Surgery Research Group, SERGAS-UVIGO, Galicia Sur Health Research Institute (IIS Galicia Sur), Vigo, Spain
| | | | | | - Ander Timoteo
- Department of General and Digestive Surgery, Doctor Josep Trueta University Hospital, Girona, Spain
| | - Lidia Cornejo
- General and digestive surgery research group. Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - José Ignacio Martín Parra
- Division of Coloproctology, Department of General and Digestive Surgery, Marqués de Valdecilla University Hospital, Santander, Spain
| | - María Fidalgo García
- Department of General and Digestive Surgery, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Alejandro Solís-Peña
- Department of General and Digestive Surgery, Coloproctology Unit, Vall d'Hebron University Hospital, Autonomic University of Barcelona, Barcelona, Spain
| | - Arturo Cirera de Tudela
- Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Araceli Rodriguez González
- Department of General and Digestive Surgery, Emergency Surgery Unit, Donostia University Hospital, San Sebastián, Spain
| | - Luís Sánchez-Guillen
- Department of General and Digestive Surgery, Coloproctology Unit, Elche University Hospital, Alicante, Spain
| | - Carlos Bustamante Recuenco
- Department of General and Digestive Surgery, Nuestra Señora del Prado Hospital, Talavera de la Reina, Toledo, Spain
| | - Carla Pérez-Alonso
- Department of General and Digestive Surgery, La Fe University Hospital, Valencia, Spain
| | - Elena Hurtado Caballero
- Department of General and Digestive Surgery, Coloproctology Unit, Gregorio Marañón University Hospital, Madrid, Spain
| | - Marta Pascual
- Department of General and Digestive Surgery, Coloproctology Unit, Hospital del Mar, Barcelona, Spain
| | - Javier García Septiem
- Department of General and Digestive Surgery, La Princesa University Hospital, Madrid, Spain
| | - Laura Mora López
- Department of General and Digestive Surgery, Parc Taulí University Hospital, Sabadell, Spain
| | - Jorge Cervera-Aldama
- Coloproctology Unit. General and Digestive Surgery Department. Cruces University Hospital. Barakaldo, Bizkaia, Spain
| | - Héctor Guadalajara
- Department of General and Digestive Surgery, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Eloy Espín
- Department of General and Digestive Surgery, Coloproctology Unit, Vall d'Hebron University Hospital, Autonomic University of Barcelona, Barcelona, Spain
| | - Esther Kreisler
- Department of General and Digestive Surgery, Coloproctology Unit, Bellvitge University Hospital, Barcelona, Spain; University of Barcelona and IBIDELL (Bellvitge Biomedical Investigation Institute), Barcelona, Spain
| |
Collapse
|
|
24
|
Perioperative and oncologic outcomes of interval colectomy performed by acute care surgeons after stenting as a bridge to surgery for left-sided malignant colonic obstruction are non-inferior to the outcomes of colorectal surgeons in the elective setting: single center experience. Eur J Trauma Emerg Surg 2022; 48:4651-4660. [PMID: 35708740 DOI: 10.1007/s00068-022-02015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/23/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To analyze if perioperative and oncologic outcomes with stenting as a bridge to surgery (SEMS-BS) and interval colectomy performed by acute care surgeons for left-sided occlusive colonic neoplasms (LSCON) are non-inferior to those obtained by colorectal surgeons for non-occlusive tumors of the same location in the full-elective context. METHODS From January 2011 to January 2021, patients with LSCON at University Regional Hospital in Málaga (Spain) were directed to a SEMS-BS strategy with an interval colectomy performed by acute care surgeons and included in the study group (SEMS-BS). The control group was formed with patients from the Colorectal Division elective surgical activity dataset, matching by ASA, stage, location and year of surgery on a ratio 1:2. Stages IV or palliative stenting were excluded. Software SPSS 23.0 was used to analyze perioperative and oncologic (defined by overall -OS- and disease free -DFS-survival) outcomes. RESULTS SEMS-BS and control group included 56 and 98 patients, respectively. In SEMS-BS group, rates of technical/clinical failure and perforation were 5.35% (3/56), 3.57% (2/56) and 3.57% (2/56). Surgery was performed with a median interval time of 11 days (9-16). No differences between groups were observed in perioperative outcomes (laparoscopic approach, primary anastomosis rate, morbidity or mortality). As well, no statistically significant differences were observed in OS and DFS between groups, both compared globally (OS:p < 0.94; DFS:p < 0.67, respectively) or by stages I-II (OS:p < 0.78; DFS:p < 0.17) and III (OS:p < 0.86; DFS:p < 0.70). CONCLUSION Perioperative and oncologic outcomes of a strategy with SEMS-BS for LSCON are non-inferior to those obtained in the elective setting for non-occlusive neoplasms in the same location. Technical and oncologic safety of interval colectomy performed on a semi-scheduled situation by acute care surgeons is absolutely warranted.
Collapse
|
|
25
|
Kim SH, Jang SH, Jeon HJ, Choi HS, Kim ES, Keum B, Jeen YT, Chun HJ, Kim J. Colonic stenting as a bridge to surgery for obstructive colon cancer: is it safe in the long term? Surg Endosc 2022; 36:4392-4400. [PMID: 35075522 DOI: 10.1007/s00464-021-08789-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/17/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND The placement of a self-expanding metal stent in patients with obstructive colon cancer is used as a bridge to surgery. However, due to a lack of consensus and insufficient data, the long-term oncologic outcomes after colonic SEMS placement remain unclear. We assessed the long-term oncologic outcomes and adverse effects of colonic stenting for malignant colonic obstruction. METHODS We included 198 patients admitted to Korea University Anam Hospital between 2006 and 2014 for obstructive colon cancer, of whom 98 underwent SEMS placement as a bridge to surgery and 100 underwent direct surgery without stenting. The clinicopathologic characteristics, overall survival, and disease-free survival were compared. RESULTS There were no significant differences in long-term oncologic outcomes between the two groups. The median follow-up durations were 61.55 and 58.64 months in the SEMS and DS groups, respectively. There were also no significant differences in the 5-year OS (77.4% vs. 74.2%, p = 0.691) and 5-year DFS (61.7% vs. 71.0%, p = 0.194) rates between the groups. However, the DS group had significantly more early postoperative complications (p = 0.002). CONCLUSIONS Colonic SEMS deployment as a bridge to surgery did not negatively affect long-term oncologic outcomes when compared with DS. In addition, colonic stenting decreased early postoperative complications and reduced the time for patients to return to normal daily activities.
Collapse
Affiliation(s)
- Seung Han Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, 126-1, Anam-dong 5 ga, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Se Hyun Jang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, 126-1, Anam-dong 5 ga, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Han Jo Jeon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, 126-1, Anam-dong 5 ga, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Hyuk Soon Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, 126-1, Anam-dong 5 ga, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Eun Sun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, 126-1, Anam-dong 5 ga, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Bora Keum
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, 126-1, Anam-dong 5 ga, Seongbuk-gu, Seoul, 02841, Republic of Korea.
| | - Yoon Tae Jeen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, 126-1, Anam-dong 5 ga, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Hoon Jai Chun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, 126-1, Anam-dong 5 ga, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Jin Kim
- Division of Colorectal Surgery, Department of Surgery, Korea University College of Medicine, Robotic & MIS Center, Korea University Medical Center, Seoul, Republic of Korea.
| |
Collapse
|
|
26
|
Lueders A, Ong G, Davis P, Weyerbacher J, Saxe J. Colonic stenting for malignant obstructions-A review of current indications and outcomes. Am J Surg 2022; 224:217-227. [DOI: 10.1016/j.amjsurg.2021.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 12/08/2021] [Accepted: 12/27/2021] [Indexed: 11/01/2022]
|
|
27
|
Palla AH, Amin F, Fatima B, Shafiq A, Rehman NU, Haq IU, Gilani AUH. Systematic Review of Polyherbal Combinations Used in Metabolic Syndrome. Front Pharmacol 2021; 12:752926. [PMID: 34690784 PMCID: PMC8529216 DOI: 10.3389/fphar.2021.752926] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/20/2021] [Indexed: 01/05/2023] Open
Abstract
Background: Metabolic syndrome (MetS) is a multifactorial disease, whose main stay of prevention and management is life-style modification which is difficult to attain. Combination of herbs have proven more efficacious in multi-targeted diseases, as compared to individual herbs owing to the "effect enhancing and side-effect neutralizing" properties of herbs, which forms the basis of polyherbal therapies This led us to review literature on the efficacy of herbal combinations in MetS. Methods: Electronic search of literature was conducted by using Cinnahl, Pubmed central, Cochrane and Web of Science, whereas, Google scholar was used as secondary search tool. The key words used were "metabolic syndrome, herbal/poly herbal," metabolic syndrome, clinical trial" and the timings were limited between 2005-2020. Results: After filtering and removing duplications by using PRISMA guidelines, search results were limited to 41 studies, out of which 24 studies were evaluated for combinations used in animal models and 15 in clinical trials related to metabolic syndrome. SPICE and SPIDER models were used to assess the clinical trials, whereas, a checklist and a qualitative and a semi-quantitative questionnaire was formulated to report the findings for animal based studies. Taxonomic classification of Poly herbal combinations used in animal and clinical studies was designed. Conclusion: With this study we have identified the potential polyherbal combinations along with a proposed method to validate animal studies through systematic qualitative and quantitative review. This will help researchers to study various herbal combinations in MetS, in the drug development process and will give a future direction to research on prevention and management of MetS through polyherbal combinations.
Collapse
Affiliation(s)
- Amber Hanif Palla
- Department of Biological and Biomedical Sciences, Aga Khan University Hospital, Karachi, Pakistan
| | - Faridah Amin
- Family Medicine, Liaquat National Hospital, Karachi, Pakistan
| | - Bilqees Fatima
- Department of Pharmaceutics, Faculty of Pharmacy, Hamdard University, Karachi, Pakistan
| | - Arooj Shafiq
- Department of Bioscience, Salim Habib University, Karachi, Pakistan
| | - Najeeb Ur Rehman
- Department of Pharmacology and Toxicology, College of Pharmacy, Prince Sattam Bin Abdul Aziz University, Al Kharj, Saudi Arabia
| | - Ikram ul Haq
- National Institute of Health, Islamabad, Pakistan
| | | |
Collapse
|
|
28
|
Inoue H, Arita T, Kuriu Y, Shimizu H, Kiuchi J, Yamamoto Y, Konishi H, Morimura R, Shiozaki A, Ikoma H, Kubota T, Fujiwara H, Okamoto K, Otsuji E. Emergency Management of Obstructive Colorectal Cancer - A Retrospective Study of Efficacy and Safety in Self-expanding Metallic Stents and Trans-anal Tubes. In Vivo 2021; 35:2289-2296. [PMID: 34182508 DOI: 10.21873/invivo.12502] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/13/2021] [Accepted: 05/20/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND/AIM The self-expanding metallic stent (SEMS) has recently been used for obstructive colorectal cancer (OCRC), and reports of its use are increasing. However, the long-term results of OCRC after using SEMS remain unclear. This study investigated the characteristics of SEMS compared to trans-anal tube (TAT) and clarified the long-term results and efficacy of SEMS for OCRC. PATIENTS AND METHODS We analyzed 48 patients who required SEMS or TAT for emergent decompression of OCRC and underwent resection for OCRC between 2007 and 2019. The perioperative factors and long-term results in the two groups were evaluated. RESULTS Patients with OCRC were divided into the SEMS (n=23) and the TAT group (n=25). No significant differences were seen in background factors, complications and the 5-year overall survival after surgery (p=0.3500) between the two groups. The clinical success of decompression (p=0.0072), oral intake (p<0.0001) and change in serum albumin (p<0.0001) from decompression to surgery were significantly better in the SEMS compares to the TAT group. CONCLUSION The long-term outcomes in the SEMS group were not significantly different than in the TAT group, and nutritional status was better in patients with SEMS, suggesting that SEMS is very effective and may be the first-line treatment of OCRC.
Collapse
Affiliation(s)
- Hiroyuki Inoue
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomohiro Arita
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshiaki Kuriu
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroki Shimizu
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Jun Kiuchi
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yusuke Yamamoto
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hirotaka Konishi
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ryo Morimura
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Atsushi Shiozaki
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hisashi Ikoma
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takeshi Kubota
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Fujiwara
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuma Okamoto
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Eigo Otsuji
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| |
Collapse
|
|
29
|
Zeng WG, Liu MJ, Zhou ZX, Hu JJ, Wang ZJ. Stent as a bridge to surgery versus urgent surgery for malignant right colonic obstruction: A multicenter retrospective study. ANZ J Surg 2021; 91:E500-E506. [PMID: 34013626 DOI: 10.1111/ans.16942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/15/2021] [Accepted: 05/01/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND The impact of self-expandable metal stent (SEMS) for malignant right colonic obstruction remains undefined. The aim of this study was to compare short-term postoperative and long-term oncologic outcomes of colonic stenting as a bridge to surgery (SBTS) and urgent colectomy for patients with malignant right-sided obstruction. METHODS A total of 98 consecutive patients who underwent SEMS placement during the period 2004-2015 from three hospitals were included. For comparative analyses, patients were matched (1:2) with 196 patients treated with emergency colectomy from our prospective database. RESULTS The two groups were comparable in terms of demographics and tumor characteristics. The proportion of patients who underwent laparoscopic colectomy was higher in SBTS group than urgent colectomy group (75.5% vs. 37.2%; p < 0.001). Patients treated with SBTS were less likely to have a temporary stoma constructed (3.1% vs. 10.7%; p = 0.024). SBTS was associated with significantly less median estimated blood loss (90 vs. 100 ml; p = 0.029), shorter length of hospital stay (11 vs. 12 days; p < 0.001), lower overall postoperative complication rate (18.4% vs. 31.3%; p = 0.018), and wound-related complication rate (5.1% vs. 14.3%; p = 0.019) compared with urgent surgery. Reoperation rate, 30-day mortality, and lymph nodes harvested were not significantly different between two groups. Disease-free survival rate and overall survival rate were similar between the two groups. CONCLUSIONS SEMS insertion is safe and feasible for treating malignant right-sided obstruction. SBTS is associated with better short-term outcomes and equivalent long-term oncologic results compared with urgent colectomy.
Collapse
Affiliation(s)
- Wei-Gen Zeng
- Department of General Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Meng-Jia Liu
- Department of Ultrasound, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zhi-Xiang Zhou
- Department of Colorectal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jun-Jie Hu
- Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Wuhan, China
| | - Zhen-Jun Wang
- Department of General Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
|
30
|
Kwaan MR, Ren Y, Wu Y, Xirasagar S. Colonic Stent Use by Indication and Patient Outcomes: A Nationwide Inpatient Sample Study. J Surg Res 2021; 265:168-179. [PMID: 33940240 DOI: 10.1016/j.jss.2021.03.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 02/14/2021] [Accepted: 03/22/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Colonic stent placement can avoid urgent surgery for large bowel obstruction in selected patients. Population-wide stent utilization patterns and outcomes are unknown. MATERIALS AND METHODS Using retrospective, population-based, Nationwide Inpatient Sample data, we studied patients with colonic stents discharged during 2010-2015. The primary outcome was ostomy creation during the same hospitalization. Other outcomes were perforation or peritonitis, and in-hospital death. Associations of outcomes with stent indication were investigated, adjusting for patient-, admission-, and hospital characteristics. We estimated annual population-wide stent use volumes. RESULTS Of 4257 patients with stent placement (52% male, mean age 64.6 years), 9.9% had non-metastatic colon cancer, 12.9% metastatic colon cancer, 37.8% extracolonic malignancy (ECM), and 39.3% had benign obstruction. In 8.1% of patients, ostomy creation surgery was performed. Perforation or peritonitis occurred in 16.7%, and in-hospital death in 4.5%. Relative to ECM, ostomy creation was several-fold more likely among nonmetastatic colon cancer (adjusted odds ratio (OR) 3.4; 95%CI, 2.1-5.5), metastatic colon cancer (adjusted OR 2.5; 95%CI, 1.7-3.7), and benign obstruction patients (adjusted OR 3.1; 95%CI, 2.1-4.7). Benign obstruction was associated with high risk of perforation/peritonitis (adjusted OR 3.1 relative to non-metastatic CC (95%CI, 2.1-4.5)). Perforation/peritonitis was highly associated with inpatient death (adjusted OR 6.8 (95%CI, 4.9-9.5)). Annually, about 3,580 patients underwent stent placement, with benign obstruction showing an increasing trend (P=0.0002). CONCLUSIONS Over 75% of stent placements were done for patients with benign disease and ECM obstruction. Subsequent ostomy creation during the hospitalization was least likely among ECM patients. Rates of perforation/peritonitis in benign obstructions were concerningly high. (22.2%).
Collapse
Affiliation(s)
- Mary R Kwaan
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
| | - Yang Ren
- University of South Carolina, Department of Computer Science and Engineering, Columbia, SC
| | - Yuqi Wu
- University of South Carolina, Department of Health Services Policy and Management, Columbia, SC
| | - Sudha Xirasagar
- University of South Carolina, Department of Health Services Policy and Management, Columbia, SC
| |
Collapse
|
|
31
|
Veld JV, Beek KJ, Consten EC, ter Borg F, van Westreenen HL, Bemelman WA, van Hooft JE, Tanis PJ. Definition of large bowel obstruction by primary colorectal cancer: A systematic review. Colorectal Dis 2021; 23:787-804. [PMID: 33305454 PMCID: PMC8248390 DOI: 10.1111/codi.15479] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/10/2020] [Accepted: 11/29/2020] [Indexed: 12/12/2022]
Abstract
AIM Controversies on therapeutic strategy for large bowel obstruction by primary colorectal cancer mainly concern acute conditions, being essentially different from subacute obstruction. Clearly defining acute obstruction is important for design and interpretation of studies as well as for guidelines and daily practice. This systematic review aimed to evaluate definitions of obstruction by colorectal cancer in prospective studies. METHOD A systematic search was performed in PubMed, Embase and the Cochrane Library. Eligibility criteria included randomized or prospective observational design, publication between 2000 and 2019, and the inclusion of patients with an obstruction caused by colorectal cancer. Provided definitions of obstruction were extracted with assessment of common elements. RESULTS A total of 16 randomized controlled trials (RCTs) and 99 prospective observational studies were included. Obstruction was specified as acute in 28 studies, complete/emergency in five, (sub)acute or similar terms in four and unspecified in 78. Five of 16 RCTs (31%) and 37 of 99 cohort studies (37%) provided a definition. The definitions included any combination of clinical symptoms, physical signs, endoscopic features and radiological imaging findings in 25 studies. The definition was only based on clinical symptoms in 11 and radiological imaging in six studies. Definitions included a radiological component in 100% of evaluable RCTs (5/5) vs. 54% of prospective observational studies (20/37, P = 0.07). CONCLUSION In this systematic review, the majority of prospective studies did not define obstruction by colorectal cancer and its urgency, whereas provided definitions varied hugely. Radiological confirmation seems to be an essential component in defining acute obstruction.
Collapse
Affiliation(s)
- Joyce V. Veld
- Department of SurgeryCancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands,Department of Gastroenterology and HepatologyCancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Kim J. Beek
- Department of Gastroenterology and HepatologyNWZ AlkmaarAlkmaarThe Netherlands
| | - Esther C.J. Consten
- Department of SurgeryMeander Medical CenterAmersfoortThe Netherlands,Department of SurgeryUniversity Medical Center GroningenGroningenThe Netherlands
| | - Frank ter Borg
- Department of Gastroenterology and HepatologyDeventer HospitalDeventerThe Netherlands
| | | | - Wilhelmus A. Bemelman
- Department of SurgeryCancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Jeanin E. van Hooft
- Department of Gastroenterology and HepatologyCancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands,Department of Gastroenterology and HepatologyLeiden University Medical CenterLeidenThe Netherlands
| | - Pieter J. Tanis
- Department of SurgeryCancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| |
Collapse
|
|
32
|
Controversies of colonic stenting in obstructive left colorectal cancer: a critical analysis with meta-analysis and meta-regression. Int J Colorectal Dis 2021; 36:689-700. [PMID: 33495871 DOI: 10.1007/s00384-021-03834-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE After almost three decades since the first description of colonic stents, the controversies of its safe application continue to impede the readiness of adoption by clinicians for malignant left bowel obstruction. This review seeks to address some of the controversial aspects of stenting and its impact on surgical and oncological outcomes. METHODS Medline, Embase, and CNKI were searched for articles employing SEMS for left colonic obstruction. Outcomes analyzed include success rates, complications, and long-term survival. Pooled risk ratio (RR) and 95% confidence interval (CI) were estimated. RESULTS 36 studies were included with 2002 patients across seven randomized controlled trials and 29 observational studies. High technical (92%) and clinical (82%) success rates, and low rates of complications, including perforation (5%), were found. Those with > 8% perforation rates had poorer technical success rates than those with ≤ 8%, but there were no significant differences in 90-day in-hospital mortality and three and 5-year overall and disease-free survival. A significant increase was found in technical (RR = 1.094; CI, 1.041-1.149; p < 0.001) and clinical (RR = 1.158; CI, 1.064-1.259; p = 0.001) success rates when the duration between stenting and surgery was ≥ 2 weeks compared to < 2 weeks, but there were no significant differences in perforation rates, 90-day in-hospital mortality, and long-term survival. CONCLUSIONS Colonic stenting is safe and effective with high success rates and low complication rates. However, outcomes of higher perforation rates and optimal timing from stent till surgery remain unclear, with only a few studies reporting on these outcomes, leaving areas for future research.
Collapse
|
|
33
|
Cirocchi R, Arezzo A, Sapienza P, Crocetti D, Cavaliere D, Solaini L, Ercolani G, Sterpetti AV, Mingoli A, Fiori E. Current Status of the Self-Expandable Metal Stent as a Bridge to Surgery Versus Emergency Surgery in Colorectal Cancer: Results from an Updated Systematic Review and Meta-Analysis of the Literature. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:268. [PMID: 33804232 PMCID: PMC7998540 DOI: 10.3390/medicina57030268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 02/06/2023]
Abstract
Background: The current use of endoscopic stenting as a bridge to surgery is not always accepted in standard clinical practice to treat neoplastic colonic obstructions. Objectives: The role of colonic self-expandable metal stent (SEMS) positioning as a bridge to resective surgery versus emergency surgery (ES) for malignant obstruction, using all new data and available variables, was studied and we focused on short- and long-term results. Materials and Methods: A systematic review with meta-analysis was performed. PubMed, SCOPUS and Web of Science databases were included. The search comprised only randomized controlled trials (RCTs) investigating the interventions that included SEMS positioning versus ES. The primary outcomes were the rates of overall postoperative mortality, clinical and technical success. The secondary outcomes were the short- and long-term results. Results: A total of 12 studies were eligible for further analyses. A laparoscopic colectomy was the most common operation performed in the SEMS group, whereas the traditional open approach was commonly used in the ES group. Intraoperative colonic lavage was seldomly performed during ES. There were no differences in mortality rates between the two groups (RR 1.06, 95% CI 0.55 to 2.04; I2 = 0%). In the SEMS group, the rate of successful primary anastomosis was significantly higher in of SEMS (69.75%) than in the ES (55.07%) (RR 1.26, 95% 245 CI 1.01 to 1.57; I2 = 86%). Conversely, the upfront Hartmann procedure was performed more frequently in the ES (39.1%) as compared to the SEMS group (23.4%) (RR 0.61, 95% CI 0.45 to 0.85; I2 = 23%). The overall postoperative complications rate was significantly lower in the SEMS group (32.74%) than in the ES group (48.25%) (RR 0.61, 95% CI 0.41 to 0.91; I2 = 65%). Conclusions: In the presence of malignant colorectal obstruction, SEMS is safe and associated with the same mortality and significantly lower morbidity than the ES group. The rate of successful primary anastomosis was significantly higher than the ES group. Nevertheless, recurrence and survival outcomes are not significantly different between the two groups. The analysis of short- and long-term results can suggest the use of SEMS as a bridge to resective surgery when it is performed by an endoscopist with adequate expertise in both colonoscopy and fluoroscopic techniques and who performed commonly colonic stenting.
Collapse
Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, University of Perugia, 05100 Terni, Italy;
| | - Alberto Arezzo
- Department of Surgery, Turin University, 10133 Torino, Italy;
| | - Paolo Sapienza
- Department of Surgery, University of Rome, 00161 Rome, Italy; (D.C.); (A.V.S.); (A.M.); (E.F.)
| | - Daniele Crocetti
- Department of Surgery, University of Rome, 00161 Rome, Italy; (D.C.); (A.V.S.); (A.M.); (E.F.)
| | - Davide Cavaliere
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, 47121 Forlì, Italy;
| | - Leonardo Solaini
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40126 Bologna, Italy; (L.S.); (G.E.)
| | - Giorgio Ercolani
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40126 Bologna, Italy; (L.S.); (G.E.)
| | - Antonio V. Sterpetti
- Department of Surgery, University of Rome, 00161 Rome, Italy; (D.C.); (A.V.S.); (A.M.); (E.F.)
| | - Andrea Mingoli
- Department of Surgery, University of Rome, 00161 Rome, Italy; (D.C.); (A.V.S.); (A.M.); (E.F.)
| | - Enrico Fiori
- Department of Surgery, University of Rome, 00161 Rome, Italy; (D.C.); (A.V.S.); (A.M.); (E.F.)
| |
Collapse
|
|
34
|
Gavriilidis P, de'Angelis N, Wheeler J, Askari A, Di Saverio S, Davies JR. Diversion, resection, or stenting as a bridge to surgery for acute neoplastic left-sided colonic obstruction: a systematic review and network meta-analysis of studies with curative intent. Ann R Coll Surg Engl 2021; 103:235-244. [PMID: 33682486 DOI: 10.1308/rcsann.2020.7137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The debate on the best surgical management strategy for acute malignant left-sided colonic obstruction is ongoing. Decompressing colostomy (DC) and stenting as a bridge to surgery (SBTS) are the currently proposed alternative approaches to emergency colectomy (EC). However, the results of a traditional meta-analysis were inconclusive. Therefore, a network meta-analysis (NMA) was conducted to compare the three approaches for acute left-sided colonic obstruction. METHODS A systematic literature search of Embase, PubMed, Google Scholar and the Cochrane library was performed. A traditional meta-analysis and subsequent NMA were conducted. FINDINGS A significantly greater number of primary anastomoses were performed in the DC cohort than in the EC and SBTS cohorts. The 90-day mortality rate was significantly lower in the DC cohort than in the EC and SBTS cohorts. Higher costs were associated with the SBTS cohort (by US$2,000) than with the EC cohort. The locoregional recurrence rate was higher for the SBTS cohort than for the EC cohort. CONCLUSIONS Evidence from the first NMA suggests there may be some clinical advantages associated with DC as an alternative approach to the EC and SBTS approaches for adequately selected patients with malignant large bowel obstruction.
Collapse
Affiliation(s)
| | - N de'Angelis
- University Hospital Henri Mondor (AP-HP), Créteil, France
| | - J Wheeler
- Cambridge University Hospitals NHS Foundation Trust, UK
| | - A Askari
- Luton and Dunstable University Hospitals NHS Trust, UK
| | | | - J R Davies
- Cambridge University Hospitals NHS Foundation Trust, UK
| |
Collapse
|
|
35
|
Dolan PT, Abelson JS, Symer M, Nowels M, Sedrakyan A, Yeo HL. Colonic Stents as a Bridge to Surgery Compared with Immediate Resection in Patients with Malignant Large Bowel Obstruction in a NY State Database. J Gastrointest Surg 2021; 25:809-817. [PMID: 32939622 DOI: 10.1007/s11605-020-04790-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 09/06/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is controversy surrounding the efficacy and safety of colonic stents as a bridge to surgery compared with immediate resection in patients presenting with an acute malignant large bowel obstruction. METHODS Retrospective longitudinal cohort study using the NYS SPARCS Database. Patients with acute malignant large bowel obstruction who either had stent followed by elective surgery within 3 weeks (bridge to surgery) or underwent immediate resection between October 2009 and June 2016 in the state of New York were included. The primary outcome was rate of stoma creation at index resection. Secondary outcomes were 90-day readmission, reoperation, procedural complications, and discharge disposition. RESULTS A total of 3059 patients were included, n = 2917 (95.4%) underwent an immediate resection and n = 142 (4.6%) underwent bridge to surgery. We analyzed 139 patients in propensity score-matched groups. Patients in the bridge to surgery group were less likely than those in the immediate resection group to get a stoma at the time of surgery (OR 0.33, 95% CI 0.18-0.60). They were also less likely to be discharged to a rehabilitation facility or require a home health aide upon discharge (OR 0.36, 95% CI 0.22-0.61). There were no differences in rates of 90-day readmission, reoperation, or procedural complications between groups. DISCUSSION Colonic stenting as a bridge to surgery leads to less stoma creation, a significant quality of life advantage, compared with immediate resection. Patients should be counseled regarding these potential benefits when the technology is available.
Collapse
Affiliation(s)
- Patrick T Dolan
- Department of Surgery, Weill Medical College of Cornell University, New York-Presbyterian Hospital, 525 East 68th Street, Box 172, New York, NY, 10065, USA
| | - Jonathan S Abelson
- Department of Surgery, Weill Medical College of Cornell University, New York-Presbyterian Hospital, 525 East 68th Street, Box 172, New York, NY, 10065, USA
| | - Matthew Symer
- Department of Surgery, Weill Medical College of Cornell University, New York-Presbyterian Hospital, 525 East 68th Street, Box 172, New York, NY, 10065, USA
| | - Molly Nowels
- Department of Healthcare Policy and Research, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, NY, USA
| | - Art Sedrakyan
- Department of Healthcare Policy and Research, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, NY, USA
| | - Heather L Yeo
- Department of Surgery, Weill Medical College of Cornell University, New York-Presbyterian Hospital, 525 East 68th Street, Box 172, New York, NY, 10065, USA. .,Department of Healthcare Policy and Research, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, NY, USA.
| |
Collapse
|
|
36
|
Long-term Oncologic Results After Stenting as a Bridge to Surgery Versus Emergency Surgery for Malignant Left-sided Colonic Obstruction: A Multicenter Randomized Controlled Trial (ESCO Trial). Ann Surg 2020; 272:703-708. [PMID: 32833762 DOI: 10.1097/sla.0000000000004324] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess overall (OS), time to progression (TTP), and disease-free survival (DFS) at 3 years after treatment, comparing stenting as bridge-to-surgery (SBTS) versus emergency surgery (ES) in neoplastic left colon obstruction, secondary endpoints of the previously published randomized controlled trial. BACKGROUND While SBTS in neoplastic colon obstruction may reduce morbidity and need for a stoma compared with ES, concern has been raised, about long-term survival. METHODS Individuals affected by left-sided malignant large-bowel obstruction were enrolled from 5 European hospitals and randomly assigned (1:1 ratio) to receive SBTS or ES. The computer-generated randomization sequence was stratified by center on cT and concealed by the use of a web-based application. Investigators and participants were unmasked to treatment assignment. The secondary outcomes analyzed here were OS, TTP, and DFS. Analysis was by intention to treat. This study is registered, ID-code NCT00591695. RESULTS Between March 2008 and November 2015, 144 patients were randomly assigned to undergo either SBTS or ES; 115 (SBTS n = 56, ES n = 59) were eligible for analysis, while 20 participants were excluded for a benign disease, 1 for unavailability of the endoscopist while 8 withdrew from the trial. With a median follow-up of 37 months (range 1-62), no difference was observed in the SBTS group compared with ES in terms of OS (HR 0.93 (95% CI 0.49-1.76), P = 0.822), TTP (HR 0.81 (95% CI 0.42-1.54), P = 0.512), and DFS (HR 1.01 (95% CI 0.56-1.81), P = 0.972). Planned subgroup analysis showed no difference in respect to age, sex, American Society for Anesthesiology score, body mass index, and pT between SBTS and ES groups. Those participants randomized for the SBTS group whose obstruction was located in the descending colon had a better TTP compared with ES group (HR 0.44 (95% CI 0.20-0.97), P = 0.042), but no difference was observed in terms of OS (HR 0.73 (95% CI 0.33-1.63), P = 0.442) and DFS (HR 0.68 (95% CI 0.34-1.34), P = 0.261) in the same individuals. CONCLUSIONS This randomized controlled trial shows that, although not powered for these seconday outcomes, OS, TTP, and DFS did not differ between groups at a minimum follow-up of 36 months.
Collapse
|
|
37
|
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; 20:255. [PMID: 33109142 PMCID: PMC7592574 DOI: 10.1186/s12893-020-00908-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/12/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To explore the long-term oncological safety of using self-expanding metal stents (SEMS) as a bridge to surgery for acute obstructive colorectal cancer by comparing the pathological results of emergency surgery (ES) with elective surgery after the placement of SEMS. METHODS Studies comparing SEMS as a bridge to surgery with emergency surgery for acute obstructive colorectal cancer were retrieved through the databases of Pubmed, Embase, and Cochrane libraries, and a meta-analysis was conducted based on the pathological results of the two treatments. Risk ratios (OR) or mean differences (MD) with 95% confidence intervals (CI) were calculated for the outcomes under random effects model. RESULTS A total of 27 studies were included, including 3 randomized controlled studies, 2 prospective studies, and 22 retrospective studies, with a total of 3737 patients. The presence of perineural invasion (RR = 0.58, 95% CI 0.48, 0.71, P < 0.00001), lymphovascular invasion (RR = 0.68, 95% CI 0.47, 0.99, P = 0.004) and vascular invasion (RR = 0.66, 95% CI 0.45, 0.99, P = 0.04) in SEMS group were significantly higher than those in ES group, and there was no significant difference in lymphatic invasion (RR = 0.92, 95% CI 0.77, 1.09, P = 0.33). The number of lymph nodes harvested in SEMS group was significantly higher than that in ES group (MD = - 3.18, 95% CI - 4.47, - 1.90, P < 0.00001). While no significant difference was found in the number of positive lymph nodes (MD = - 0.11, 95% CI - 0.63, 0.42, P = 0.69) and N stage [N0 (RR = 1.03, 95% CI 0.92, 1.15, P = 0.60), N1 (RR = 0.99, 95% CI 0.87, 1.14, P = 0.91), N2 (RR = 0.94, 95% CI 0.77, 1.15, P = 0.53)]. CONCLUSIONS SEMS implantation in patients with acute malignant obstructive colorectal cancer may lead to an increase in adverse tumor pathological characteristics, and these characteristics are mostly related to the poor prognosis of colorectal cancer. Although the adverse effect of SEMS on long-term survival has not been demonstrated, their adverse effects cannot be ignored. The use of SEMS as the preferred treatment for patients with resectable obstructive colorectal cancer remains to be carefully weighed, especially when patients are young or the surgical risk is not very high.
Collapse
|
|
38
|
Boeding JRE, Ramphal W, Rijken AM, Crolla RMPH, Verhoef C, Gobardhan PD, Schreinemakers JMJ. A Systematic Review Comparing Emergency Resection and Staged Treatment for Curable Obstructing Right-Sided Colon Cancer. Ann Surg Oncol 2020; 28:3545-3555. [PMID: 33067743 DOI: 10.1245/s10434-020-09124-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 08/31/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Treatment for obstructing colon cancer (OCC) is controversial because the outcome of acute resection is less favorable than for patients without obstruction. Few studies have investigated curable right-sided OCC, and patients with OCC usually undergo acute resection. This study aimed to better understand the outcome and best management of potentially curable right-sided OCC. METHODS A systematic review of studies was performed with a focus on differences in mortality and morbidity between emergency resection and staged treatment for patients with potentially curable right-sided OCC. In March 2019, the study searched Embase, Medline, Web of Science, Cochrane, and Google scholar databases according to PRISMA guidelines using search terms related to "colon tumour," "stenosis or obstruction and surgery," and "decompression or stents." All English-language studies reporting emergency or staged treatment for potentially curable right-sided OCC were included in the review. Emergency resection and staged resection were compared for mortality, morbidity, complications, and survival. RESULTS Nine studies were found to be eligible and comprised 600 patients treated with curative intent for their right-sided OCC by emergency resection or staged resection. The mean overall complication rate was 42% (range 19-54%) after emergency resection, and 30% (range 7-44%) after staged treatment. The average mortality rate was 7.2% (range 0-14.5%) after emergency resection and 1.2% (range 0-6.3%) after staged treatment. The 5-year disease-free and overall survival rates were comparable for the two treatments. CONCLUSIONS The patients who received staged treatment for right-sided OCC had lower mortality rates, fewer complications, and fewer anastomotic leaks and stoma creations than the patients who had emergency resection.
Collapse
Affiliation(s)
- Jeske R E Boeding
- Department of Surgery, Amphia Hospital, Breda, The Netherlands. .,Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - Winesh Ramphal
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
| | - Arjen M Rijken
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
| | | | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | | |
Collapse
|
|
39
|
Long-term outcomes of colonic stent as a "bridge to surgery"for left-sided malignant large-bowel obstruction. Surg Oncol 2020; 35:399-405. [PMID: 33035788 DOI: 10.1016/j.suronc.2020.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 09/15/2020] [Accepted: 09/27/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The role of self-expandable metallic stents (SEMS) as a bridge to surgery in left-sided malignant colonic obstruction is still debated. Here we assess the morbidity, mortality and long-term oncological outcomes as a bridge to surgery for patients with left-sided malignant colonic obstruction. METHOD Prospective observational study with retrospective analysis of patients with left-sided malignant colonic obstruction undergoing stenting. April 2006-April 2018. We assessed all patients with intent-to treat and per protocol analyses and long-term follow-up variables. RESULTS Colonic stent was performed in 117 patients. Technical and clinical success of SEMS placement: 94.4% (111/117), only 4.3% perforation. Elective surgery resection following the strategy of SEMS was performed in 83.8% (98/117). A laparoscopic approach was: 25.6% (30/117); 76.9% in the last two years. Primary anastomosis rate: 92.8% (91/98), without protective stoma in any patients. Anastomotic leakage rate: 8.2% (8/97). Median follow-up: 44.5 months (range 0-109). The intent-to-treat analysis showed overall and disease-free survival rates of 63.3% (74/117) and 58.1% (68/117), and local and distant recurrence rates: 9.4% (11/117) and 58.1% (68/117). In the per protocol analysis, overall and disease-free survival rates: 63.2% (62/98) and 60.2% (58/98), and local and distant recurrence rates: 10.2% (10/98) and 36.7% (36/98). Disease progression was predominantly observed during the first 5 years' follow-up as disease recurrence; after five years' follow-up, 60% of the patients were disease-free. CONCLUSIONS According to the results of the study SEMS as a bridge to surgery achieves perioperative results comparable to non-occlusive colonic cancer surgery and does not adversely affect long-term oncological outcomes. Further investigations are needed.
Collapse
|
|
40
|
Lauro A, Binetti M, Vaccari S, Cervellera M, Tonini V. Obstructing Left-Sided Colonic Cancer: Is Endoscopic Stenting a Bridge to Surgery or a Bridge to Nowhere? Dig Dis Sci 2020; 65:2789-2799. [PMID: 32583222 DOI: 10.1007/s10620-020-06403-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
For the 8-29% colorectal cancers that initially manifest with obstruction, emergency surgery (ES) was traditionally considered the only available therapy, despite high morbidity and mortality rates and the need for colostomy creation. More recently, malignant obstruction of the left colon can be temporized by endoscopic placement of a self-expanding metallic stent (SEMS), used as bridge to surgery (BTS), facilitating a laparoscopic approach and increasing the likelihood that a primary anastomosis instead of stoma would be used. Despite these attractive outcomes, the superiority of the BTS approach is not clearly established. Few authors have stressed the potential cancer risk associated with perforations that may occur during endoscopic stent placement, facilitating neoplastic spread and negatively impacting prognosis. For this reason, the current literature focuses on long-term oncologic outcomes such as disease-free survival, overall survival and recurrence rate that do seem not to differ between the ES and BTS approaches. This lack of consensus has spawned differing and sometimes discordant guidelines worldwide. In conclusion, 20 years after the first description of a colonic stent as BTS, the debate is still open, but the growing number of articles about the use of SEMS as a BTS signifies a great interest in the topic. We hope that these data will finally converge on a single set of recommendations supporting a management strategy with well-demonstrated superiority.
Collapse
Affiliation(s)
- Augusto Lauro
- Emergency Surgery Department, St. Orsola University Hospital, Bologna, Italy
| | - Margherita Binetti
- Emergency Surgery Department, St. Orsola University Hospital, Bologna, Italy
| | - Samuele Vaccari
- Department of Surgical Sciences, Umberto I University Hospital - La Sapienza, Rome, Italy.
| | - Maurizio Cervellera
- Emergency Surgery Department, St. Orsola University Hospital, Bologna, Italy
| | - Valeria Tonini
- Emergency Surgery Department, St. Orsola University Hospital, Bologna, Italy
| |
Collapse
|
|
41
|
Skelton WP, Franke AJ, Iqbal A, George TJ. Comprehensive literature review of randomized clinical trials examining novel treatment advances in patients with colon cancer. J Gastrointest Oncol 2020; 11:790-802. [PMID: 32953161 PMCID: PMC7475336 DOI: 10.21037/jgo-20-184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 07/20/2020] [Indexed: 12/18/2022] Open
Abstract
The treatment of colon cancer has had numerous recent advances, in terms of surgical approach, adjuvant therapies, and more. In this review, the authors examine randomized clinical trials comparing open surgery to laparoscopic surgery (including total mesocolic excision), and also examine the role of robotic surgery. Novel surgical techniques including the no-touch technique, side-to-side anastomosis, suture technique, complete mesocolic excision (CME) with central vascular ligation (CVL), and natural orifice transluminal endoscopic surgery (NOTES) are outlined. The role of placing endoscopic self-expandable metal stents (SEMS) for colonic obstruction is compared and contrasted with the surgical approach, and the effect that the anti-VEGF inhibitor bevacizumab may have on this side effect profile is further explored. The role of the resection of the primary tumor in the setting of metastatic disease is examined with respect to survival benefit. Pathways of perioperative care which can accelerate post-surgical recovery, including enhanced recovery after surgery (ERAS) are examined. The role of adjuvant chemotherapy in patients with high-risk stage II and patients with stage III disease is examined, along with the role on circulating tumor DNA (ctDNA) as well as with the biologic targeted agents cetuximab and bevacizumab. Lastly, the authors detail the postoperative surveillance schedules after surgical resection with respect to survival outcomes.
Collapse
Affiliation(s)
- William Paul Skelton
- Division of Medical Oncology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Florida, USA
| | - Aaron J. Franke
- Division of Medical Oncology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Florida, USA
| | - Atif Iqbal
- Section of Colorectal Surgery, Baylor College of Medicine, Houston, USA
| | - Thomas J. George
- Division of Hematology & Oncology, Department of Medicine, University of Florida College of Medicine, Florida, USA
| |
Collapse
|
|
42
|
Long-term outcomes of stent-related perforation in malignant colon obstruction: a systematic review and meta-analysis. Int J Colorectal Dis 2020; 35:1439-1451. [PMID: 32572603 DOI: 10.1007/s00384-020-03664-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE The placement of self-expandable metallic stents as a bridge to surgery in malignant colon obstruction is concerning due to the long-term oncological results reported in recent published studies. The aim of this study was to evaluate the oncological consequences of stent-related perforations in patients with malignant colon obstruction and potentially curable disease. METHODS MEDLINE, Cochrane Library, Ovid and ISRCTN Registry were searched, with no restrictions. We performed five meta-analyses to estimate the pooled effect sizes by using a random-effect model. The outcomes were global, locoregional and systemic recurrence rate and 3 and 5 year-survival rate depending on the presence or absence of stent-related perforation. RESULTS Thirteen studies (950 patients) were included. The overall rate of stent-related perforation was 8.9%. The global recurrence rate was significantly higher in stent-related perforation group (41.2 vs. 30.8%; OR 1.70; 95%CI: 1.02-2.84; p = 0.04). Locoregional recurrence rate was higher in the perforated group than in the non-perforated group (26.6 vs. 12.5%), with statistically significant differences (OR 2.41; 95% CI:1.33-4.34; p = 0.004). No significant differences were found in systemic recurrence rate (13.6 vs. 20.5%; OR 0.77; 95%CI: 0.35-1.7; p = 0.51); 3-year overall survival rate (65.4 vs. 74.8%; OR 0.63; 95% CI:0.29-1.39; p = 0.25) and 5-year overall survival rate (48.3 vs. 58.6%; OR 0.67; 95%CI: 0.27-1.65; p = 0.38). CONCLUSION Stent-related perforation is associated with an increased risk of global and locoregional recurrence. The successful placement of the stent as a bridge to surgery in the curative purpose of patients with obstructed colon cancer does not exclude the presence of underlying perforation, with the consequent danger of disease spread. PROSPERO registration number: CRD42020152817.
Collapse
|
|
43
|
Spannenburg L, Sanchez Gonzalez M, Brooks A, Wei S, Li X, Liang X, Gao W, Wang H. Surgical outcomes of colonic stents as a bridge to surgery versus emergency surgery for malignant colorectal obstruction: A systematic review and meta-analysis of high quality prospective and randomised controlled trials. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 46:1404-1414. [PMID: 32418754 DOI: 10.1016/j.ejso.2020.04.052] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/28/2020] [Indexed: 02/06/2023]
Abstract
Self-expanding metallic stent placement as a bridge to surgery has been reported as an alternative to emergency surgery for acute malignant colorectal obstruction. However, results from clinical trials and previous meta-analyses are conflicting. We carried out a meta-analysis to compare the surgical and oncological outcomes between emergency surgery and self-expanding metallic stents for malignant large bowel obstruction. Pubmed, Embase, CINAHL, Web of Science and Cochrane were searched for prospective and randomised controlled trials. The outcomes of focus included 3- and 5-year overall and disease-free survival, overall tumour recurrence, overall complication and 30-day mortality rate, length of hospital and ICU stay, overall blood loss, number of patients requiring transfusion, total number of lymph nodes harvested, stoma and primary anastomosis rate. Twenty-seven studies were included with a total of 3894 patients. There was no significant difference in terms of 3-year and 5-year disease-free and overall survival. Stenting resulted in less blood loss (mean difference -234.72, P < 0.00001) and higher primary anastomosis rate (RR 1.25, P < 0.00001). For curative cases, bridge to surgery groups had lower 30-day mortality rate (RR 0.65, P = 0.01), lower overall complication rate (RR 0.65, P < 0.0001), more lymph nodes harvested (mean difference 2.51, P = 0.005), shorter ICU stay (mean difference -2.27, P = 0.02) and hospital stay (mean difference -7.24, 95% P < 0.0001). Compared to emergency surgery, self-expanding metallic stent interventions improve short-term surgical outcomes, especially in the curative setting, but have similar long-term oncological and survival outcomes.
Collapse
Affiliation(s)
- Liam Spannenburg
- The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, QLD, 4102, Australia; Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Mariana Sanchez Gonzalez
- The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, QLD, 4102, Australia
| | - Anastasia Brooks
- The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, QLD, 4102, Australia
| | - Shujun Wei
- Department of Colorectal Surgery, Changzheng Hospital, Naval Medical University, Shanghai, 200433, China
| | - Xinxing Li
- Department of Colorectal Surgery, Changzheng Hospital, Naval Medical University, Shanghai, 200433, China
| | - Xiaowen Liang
- The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, QLD, 4102, Australia; Department of Colorectal Surgery, Changzheng Hospital, Naval Medical University, Shanghai, 200433, China; Gallipoli Medical Research Institute, Greenslopes Private Hospital, Brisbane, QLD, Australia
| | - Wenchao Gao
- Department of Colorectal Surgery, Changzheng Hospital, Naval Medical University, Shanghai, 200433, China.
| | - Haolu Wang
- The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, QLD, 4102, Australia; Gallipoli Medical Research Institute, Greenslopes Private Hospital, Brisbane, QLD, Australia; Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| |
Collapse
|
|
44
|
Bergamini C, Giordano A, Maltinti G, Alemanno G, Cianchi F, Coratti A, Manetti R, Valeri A, Prosperi P. Obstructive left side colon cancer: time for a tailored operative approach? MINERVA CHIR 2020; 75:244-254. [PMID: 32456396 DOI: 10.23736/s0026-4733.20.08299-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) obstruction is frequent but doubts remain on the best treatment. The aim of this study is to analyze the different operative approach used for CRC treatment and evaluate the outcomes for the different cases. METHODS Patients were collected from January 2014 to December 2019 and divided in four groups: two "P" groups, namely the Hartmann's procedure (PH) group and the primary anastomosis (PA) group, and two "S" groups, namely the deviating stoma (SD) group and the self-expanding metallic stent (SS) group. The main endpoints were the quality of life and the oncologic safety. RESULTS One hundred and eight patients were enrolled. The mean follow-up time was 39 months. The stomas were performed less frequently in SS but lasted more in that group. Only 45% underwent reversal surgery. Cumulative operating time was greater in S versus P groups. The rate of major complications was similar. PA had greater overall survival and disease-free survival rates than PH. CONCLUSIONS The various options of treatment should have different indications: primary anastomosis in stable patients, Hartmann in critical cases, SEMS for palliative intent and stoma when neo-adjuvant therapy is needed.
Collapse
Affiliation(s)
- Carlo Bergamini
- Unit of Emergency Surgery, Department of Emergency, Careggi University Hospital, Florence, Italy -
| | - Alessio Giordano
- Unit of Emergency Surgery, Department of Emergency, Careggi University Hospital, Florence, Italy
| | - Gherardo Maltinti
- Unit of Emergency Surgery, Department of Emergency, Careggi University Hospital, Florence, Italy
| | - Giovanni Alemanno
- Unit of Emergency Surgery, Department of Emergency, Careggi University Hospital, Florence, Italy
| | - Fabio Cianchi
- Department of Emergency, Unit of General and Endocrine Surgery, Careggi University Hospital, Florence, Italy
| | - Andrea Coratti
- Department of Robotic Oncologic Surgery, Careggi University Hospital, Florence, Italy
| | - Roberto Manetti
- Unit of Operative Endoscopy, Department of Robotic Oncologic Surgery, Careggi University Hospital, Florence, Italy
| | - Andrea Valeri
- Unit of Emergency Surgery, Department of Emergency, Careggi University Hospital, Florence, Italy
| | - Paolo Prosperi
- Unit of Emergency Surgery, Department of Emergency, Careggi University Hospital, Florence, Italy
| |
Collapse
|
|
45
|
Fluoroscopic Stenting as a Bridge to Surgery versus Emergency Management for Malignant Obstruction of the Colon. Emerg Med Int 2020; 2020:4650780. [PMID: 32566301 PMCID: PMC7284933 DOI: 10.1155/2020/4650780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/18/2020] [Accepted: 05/16/2020] [Indexed: 11/18/2022] Open
Abstract
Aim To investigate the feasibility of a SEMS (self-expandable metallic stent) as a bridge to surgery for malignant colonic obstruction. Methods We retrospectively reviewed 83 patients that were in accordance with inclusion criteria; of these, 33 patients that underwent fluoroscopy-guided SEMS placement followed by elective curative resection were classified as a SEMS group and 50 patients, who received emergency surgery (ES), were classified as an ES group. The clinicopathological characteristics, surgery-related parameters, complications, and three-year survival rate were compared between the two groups. Results No significant differences between the two groups were observed in any of the clinicopathologic characteristics except for higher preoperative absolute neutrophil count in the ES group (P < 0.001). Compared to the ES group, the SEMS group has significantly more cases, which featured a laparoscopic approach (72.7% vs. 14.0%, P < 0.001), lower overall stoma rate (0% vs. 34.0%, P < 0.001), and lower overall postoperative morbidity (27.3% vs. 56.0%, P=0.010). The oncological outcomes did not differ significantly between the two groups in terms of three-year overall survival (P=0.125). The technical and clinical success rates of stent placement were 91.7% and 100%, respectively. Conclusion Patients treated with the stent-surgery approach had significant short-term superiorities and similar long-term outcomes, compared to patients who had emergency surgery alone. The SEMS is, therefore, safe and feasible as a bridge to surgery for malignant colonic obstruction.
Collapse
|
|
46
|
The optimal time interval between the placement of self-expandable metallic stent and elective surgery in patients with obstructive colon cancer. Sci Rep 2020; 10:9502. [PMID: 32528099 PMCID: PMC7289825 DOI: 10.1038/s41598-020-66508-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 05/21/2020] [Indexed: 02/08/2023] Open
Abstract
A bridge to surgery (BTS) after a colonic stent for obstructive colon cancer has not been accepted as a standard treatment strategy. Also, there is no consensus regarding the optimal time interval for BTS. We aimed to identify the optimal timing for BTS after stent placement to decrease the oncologic risk. We retrospectively collected data of 174 patients who underwent BTS after stent placement for stage II or III obstructive colon cancer from five hospitals. We divided the patients into three groups based on the time interval for BTS after stent placement: within 7 days (Group 1), from 8 to 14 days (Group 2), and after 14 days (Group 3). The primary outcome was to compare the oncologic outcomes including overall survival (OS), disease-free survival (DFS), and recurrence rate (RR) among the three groups. Groups 1, 2, and 3 involved 75, 56, and 43 patients, respectively. Postoperative morbidity rates were 17.3%, 10.8%, and 9.3% in Groups 1, 2, and 3, respectively (P = 0.337). RRs were 16.0%, 35.7%, and 30.2% in Groups 1, 2, and 3, respectively (P = 0.029). In multivariate analysis, the time interval for BTS was an independent risk factor for DFS (P < 0.001; HR, 14.463; 95% CI, 1.458–3.255) and OS (P = 0.027; HR, 4.917; 95% CI, 1.071–3.059). In conclusion, the perioperative short-term outcome was not affected by the time interval of BTS. However, elective surgery within 7 days after colonic stent might be suggested to balance the short-term benefits and long-term oncologic risks.
Collapse
|
|
47
|
Chan DKH, Tan KK. Stenting versus surgery in obstructed malignant colorectal cancer-a review of short and long-term results. J Gastrointest Oncol 2020; 11:486-490. [PMID: 32655926 PMCID: PMC7340803 DOI: 10.21037/jgo.2020.01.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 01/09/2020] [Indexed: 12/27/2022] Open
Abstract
Obstructed colorectal cancers (CRCs) continue to be challenging to manage. Apart from surgical resection, the use of self-expanding metallic stents (SEMS) has become increasingly popular. SEMS could potentially allow for the conversion of an emergency operation into a semi-elective procedure, allow for the optimization of the patient's physiology, avoid the requirement for a stoma, as well as allow for a minimally-invasive approach to be adopted. This review article therefore highlights the evidence available in the literature pertaining to the use of SEMS in obstructed CRCs.
Collapse
Affiliation(s)
- Dedrick Kok Hong Chan
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ker-Kan Tan
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
|
48
|
Hanaoka M, Ogo T, Kawamura Y, Miura T, Aburatani T, Sugimoto H, Hoshino N, Yauchi T, Nishioka Y, Kawano T. Self-expandable Metal Stent as a Bridge to Surgery for Colorectal Cancer: Safety and Oncological Outcomes. In Vivo 2020; 34:1325-1331. [PMID: 32354926 DOI: 10.21873/invivo.11909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/07/2020] [Accepted: 03/11/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND/AIM Self-expandable metal stent (SEMS) as a bridge to surgery (BTS) for obstructive colorectal cancer (CRC) raises concerns regarding the short-term as well as oncological outcome. The present study aimed to investigate the safety of SEMS placement and risk factors of worse short-term and oncological outcomes as BTS. PATIENTS AND METHODS Twenty-four patients with obstructive CRC who underwent SEMS placement as BTS were included. Success rate of SEMS placement and 2-year relapse-free survival (RFS) rates in stage II/III BTS patients were assessed. RESULTS Technical and clinical success rates for SEMS placement were 100% and 87.5%, respectively. In Multivariate analyses, longer tumour length, longer interval to surgery, and angular positioning were risk factors related with the complication of stent placement. Two-year RFS rates were significantly higher in the no-complication than in the complication group (100% vs. 75%, log-rank test, p<0.01). CONCLUSION A long tumour length, long interval between SEMS insertion and surgery, and angular positioning of the SEMS were identified as risk factors for SEMS-related complications. Moreover, SEMS insertion and/or surgery complications were associated with worse oncological outcome in CRC patients.
Collapse
Affiliation(s)
- Marie Hanaoka
- Department of Surgery, Soka Municipal Hospital, Soka, Japan
| | - Taichi Ogo
- Department of Surgery, Soka Municipal Hospital, Soka, Japan
| | - Yudai Kawamura
- Department of Surgery, Soka Municipal Hospital, Soka, Japan
| | - Tomiyuki Miura
- Department of Surgery, Soka Municipal Hospital, Soka, Japan
| | | | | | - Naoaki Hoshino
- Department of Surgery, Soka Municipal Hospital, Soka, Japan
| | - Tsunehito Yauchi
- Department of Gastroenterology, Soka Municipal Hospital, Soka, Japan
| | | | | |
Collapse
|
|
49
|
Tamini N, Ceresoli M, Aldè S, Carissimi F, Ripamonti L, Nespoli L, Dinelli M, Braga M, Gianotti L. Quasi-elective left colectomy after endoscopic colon stenting for obstructive cancer yields comparable oncologic outcome to full-elective operation. Int J Colorectal Dis 2020; 35:633-640. [PMID: 32006138 DOI: 10.1007/s00384-020-03519-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Whether deferring surgery after endoscopic self-expandable metal stent (SEMS) placement for neoplastic stricture, and operating patients in a quasi-elective situation, may result in similar oncologic outcomes to elective operations is unclear. This study aimed to evaluate the disease-free survival (DFS) rates of patients who underwent an interval colon resection after SEMS placement or an elective operation with comparable cancer stages. METHODS From a prospective dataset, we retrospectively selected patients with the following characteristics: (1) left-sided colon cancer and (2) cancer stage I to III. Exclusion criteria were as follows: (1) palliative surgery and (2) emergency operation. Then we stratified patients into two groups: (A) full-elective left colon resection and (B) quasi-elective left colon resection, defined as surgery performed after SEMS placement for obstructive colon cancer. DFS function was studied by the Kaplan-Meier method. RESULTS After 1:2 matching based on cancer stage, 106 patients of the group A were compared with 53 patients of group B. In each group, there were 9.4% of stage I, 39.4% of stage II, and 50.9% of stage III patients. The rate of technical failure in SEMS placement was 3.8%. After a mean follow-up of 54 months, 16 (15.1%) patients in the full-elective groups and 10 (18.9%) in the quasi-elective group experience cancer recurrence (log rank = 0.588). DFS curve did not reach the median value. CONCLUSIONS SEMS placement with interval colon resection for obstructive neoplastic strictures seems to provide similar long-term oncologic outcomes to operations performed in an elective setting when a low rate of technical failure is achieved.
Collapse
Affiliation(s)
- Nicolò Tamini
- Department of Surgery, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy
| | - Marco Ceresoli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Simone Aldè
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | - Lorenzo Ripamonti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Luca Nespoli
- Department of Surgery, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | - Marco Braga
- Department of Surgery, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Luca Gianotti
- Department of Surgery, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy.
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
| |
Collapse
|
|
50
|
Tebala GD, Mingoli A, Natili A, Khan AQ, Brachini G. Surgical Risk and Pathological Results of Emergency Resection in the Treatment of Acutely Obstructing Colorectal Cancers: A Retrospective Cohort Study. Ann Coloproctol 2020; 37:21-28. [PMID: 32178504 PMCID: PMC7989555 DOI: 10.3393/ac.2019.03.10.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 03/10/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose The treatment of acutely obstructing colorectal cancers is still a matter of debate. The prevailing opinion is that an immediate resection should be performed whenever possible. This study sought to determine whether immediate resection is safe and oncologically valid. Methods We completed a retrospective 2-center cohort study using the medical records of patients admitted for acutely obstructing colorectal cancer under the care of the Colorectal Team, Noble’s Hospital, Isle of Man, and the Emergency Surgery Unit, Umberto I University Hospital, Rome, from March 2013 to May 2017. The primary endpoints were 90-day mortality and morbidity, reoperation rate, and length of stay. The secondary endpoints were status of margins, number of lymph nodes retrieved, and the rate of adequate nodal harvest. Results Sixty-three patients were retrospectively enrolled in the study. Mortality was associated with age > 80 years and Dukes B tumors. The length of hospital stay was shorter in patients who had their resection less than 24 hours from their admission, in those who had laparoscopic resection and in those with distal tumors. The number of lymph nodes retrieved and rate of R0 resections were similar to those reported in elective colorectal surgery and were greater in laparoscopic resections and in patients operated on within 24 hours, respectively. Conclusion Immediate resection is a safe and reliable option in patients with acutely obstructing colorectal cancer.
Collapse
Affiliation(s)
- Giovanni Domenico Tebala
- Colorectal Team, Noble's Hospital, Isle of Man, British Isles.,Surgical Emergency Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Andrea Mingoli
- Emergency Surgery Unit, "P. Valdoni" Department of Surgery, Umberto I University Hospital, Rome, Italy
| | - Andrea Natili
- Colorectal Team, Noble's Hospital, Isle of Man, British Isles.,Emergency Surgery Unit, "P. Valdoni" Department of Surgery, Umberto I University Hospital, Rome, Italy.,General and Transplantation Surgery Unit, S. Salvatore Regional Hospital, L'Aquila, Italy
| | | | - Gioia Brachini
- Emergency Surgery Unit, "P. Valdoni" Department of Surgery, Umberto I University Hospital, Rome, Italy
| |
Collapse
|