Clinical benefits and oncologic equivalence of self-expandable metallic stent insertion for right-sided malignant colonic obstruction

Ji, Woong Bae; Kwak, Jung‐Myun; Kang, Dong Woo; Kwak, Han Deok; Um, Jun Won; Lee, Sun Il; Min, Byung Wook; Sung, Nak Song; Kim, Jin; Kim, Seon Hahn

doi:10.1007/s00464-016-4946-2

Cited by 48 publications

(35 citation statements)

References 20 publications

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“…Recent studies have revealed that colonic stenting, as a bridge to elective surgery, can contribute to not only an increased rate of laparoscopic surgery but also to a decreased conversion rate [25, 26]. Although most of the present patients with preoperative ileus were managed by TPN instead of oral intake, intraoperative bowel distension was not fully improved.…”

Section: Discussionmentioning

confidence: 95%

A high preoperative Glasgow prognostic score predicts a high likelihood of conversion from laparoscopic to open surgery in patients with colon cancer

et al. 2018

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Section: Discussionmentioning

confidence: 95%

A high preoperative Glasgow prognostic score predicts a high likelihood of conversion from laparoscopic to open surgery in patients with colon cancer

et al. 2018

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“…Repici et al reported that the success rate for SEMS insertion for right-sided malignant colonic obstruction was 95% (20/21), with resolution of obstructive symptoms and no immediate complications in 85% of cases (17/20) [16]. Similarly, another recent study reported a success rate of 87.5% and symptom relief rate of 100% with no immediate complications [17]. In the present study, re-obstruction as a long-term complication occurred in only one patient.…”

Section: Discussionmentioning

confidence: 97%

“…For example, Amelung et al [22] found that patients treated with SEMS were less likely to require a temporary stoma, although there were no signi cant differences in the morbidity and mortality rates between the SEMS and ES groups. Another study reported shorter postoperative hospital stays and time to resume oral food intake in the SEMS group, suggesting better recovery from surgery [17]. However, there is a lack of multicentre randomised controlled trials to con rm the advantages in terms of morbidity or mortality of the use of colon stenting as a bridge to surgery vs ES for patients with MORC.…”

Section: Discussionmentioning

confidence: 99%

Self-expandable metallic stenting as a bridge to elective surgery versus emergency surgery for acute malignant right-sided colorectal obstruction

Cai

et al. 2020

Preprint

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Background Data are limited regarding the advantages of a self-expandable metal stent (SEMS) as a bridge to elective surgery for acute malignant obstruction of the right-sided colon (MORC), as most studies concentrated on this technique used in left-sided colon. This study aimed to evaluate the outcomes of patients (including stage IV cases) with acute MORC treated by initial SEMS placement vs emergency surgery (ES). Methods Patients with acute MORC who underwent radical resection for a primary tumour from July 2008 to November 2016 at Zhongshan Hospital of Fudan University were retrospectively enrolled. Postoperative short-term outcomes, progression-free survival (PFS), and overall survival (OS) were compared between the SEMS and ES groups. Results In total, 107 patients with acute MORC (35 in the SEMS group and 72 in the ES group) were included for analysis. The Intensive Care Unit admission rate was lower (11.4% vs. 34.7%, P = 0.011), the incidence of complications was reduced (11.4% vs. 29.2%, P = 0.042), and the postoperative length of hospitalisation was significantly shorter (8.23 ± 6.50 vs. 11.18 ± 6.71 days, P = 0.033) for the SEMS group. Survival curves showed no significant difference in PFS (P = 0.506) or OS (P = 0.989) between groups. 29.0% (27/93) of the patients with stage II and III disease experienced disease progression, when the distant metastasis rates for the SEMS and ES groups were 21.4% (6/28) and 18.5% (12/65), respectively (P = 0.740) and local site relapse presented in 2 (7.1%) patients of the SEMS group and in 7 (10.8%) patients of the ES group (P = 0.719). After colectomy for synchronous liver metastases, the hepatectomy rates for the SEMS and ES groups were 85.7% and 14.3%, respectively (P = 0.029). The hazard ratio for colectomy alone vs combined resection was 3.258 (95% CI 0.858–12.370; P = 0.041). Conclusion Stent placement offers significant advantages in terms of short-term outcomes and comparable prognoses for acute MORC patients. For synchronous liver metastases, SEMS placement better prepares the patient for resection of the primary tumour and liver metastasis, which contribute to improved survival.

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“…In the present study, we reported our experience of the endoscopy-guided only method for SEMS insertion. Since gastrointestinal endoscopy is an image-guided procedure, the therapeutic strategy can be made according to [6,10], by providing some radiological evidence. In our practice, determinations are made by reviewing images of CT scans.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Self-Expandable Metallic Stent Insertion without Fluoroscopic Guidance Is Feasible and Safe for Acute Colonic Obstruction Caused by Colorectal Cancer

Feng

et al. 2020

Gastroenterology Research and Practice

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Aims. Endoscopic self-expandable metallic stent (SEMS) insertion for acute colonic obstruction caused by colorectal cancer (CRC) is always performed under fluoroscopic guidance. This study evaluated the feasibility and safety of an endoscopic stenting procedure without fluoroscopic guidance. Methods. A total of 36 patients with an acute colonic obstruction caused by CRC underwent endoscopic SEMS insertion using a colonoscope without fluoroscopic guidance, followed by analyses of the technical and clinical success and short-term complications. Results. Total technical success rate and clinical success rate were 91.7% and 86.1%, respectively. The mean procedure time was 21.2±10.3 minutes. There was no stent dislodgement. One case of hematochezia and two cases of tenesmus occurred in patients with left-sided complete obstructions. No other short-term complications occurred. Procedure time, technical success, and clinical success rate were 16.3±9.4 minutes, 93.1%, and 89.6% for left-sided obstructions, respectively, and were 26.8±10.7 minutes, 85.7%, and 71.4% for right-sided obstructions, respectively. For complete obstructions, procedure time, technical success, and clinical success rate were 22.5±8.9 minutes, 90%, and 83.3%, respectively. In the incomplete cases, procedure time, technical success, and clinical success were 13.5±6.7 minutes, 100%, and 100%, respectively. Technical success, clinical success, and short-term complications were not differed between lesion locations and degrees. Conclusions. This simple technique is feasible and safe for palliation of acute colonic obstruction caused by CRC.

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Clinical benefits and oncologic equivalence of self-expandable metallic stent insertion for right-sided malignant colonic obstruction

Abstract: Stent insertion appears to be safe and feasible in patients with right-sided colonic malignant obstruction. It facilitates minimally invasive surgery and may result in better short-term surgical outcomes.

Cited by 48 publications

References 20 publications

A high preoperative Glasgow prognostic score predicts a high likelihood of conversion from laparoscopic to open surgery in patients with colon cancer

A high preoperative Glasgow prognostic score predicts a high likelihood of conversion from laparoscopic to open surgery in patients with colon cancer

Self-expandable metallic stenting as a bridge to elective surgery versus emergency surgery for acute malignant right-sided colorectal obstruction

Endoscopic Self-Expandable Metallic Stent Insertion without Fluoroscopic Guidance Is Feasible and Safe for Acute Colonic Obstruction Caused by Colorectal Cancer

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