Comparative study between colonic metallic stent and anal tube decompression for Japanese patients with left-sided malignant large bowel obstruction

Abstract

BackgroundSurgical management of malignant bowel obstruction carries with high morbidity and mortality. Placement of a trans-anal decompression tube (TDT) has traditionally been used for malignant bowel obstruction as a bridge to surgery. Recently, colonic metallic stent (CMS) as a bridge to surgery for malignant bowel obstruction, particularly left-sided malignant large bowel obstruction (LMLBO) caused by colorectal cancer, has been reported to be both a safe and feasible option. The aim of this retrospective study is to evaluate the clinical effects of CMS for LMLBO as a bridge to surgery compared to TDT.MethodsBetween January 2000 and December 2015, we retrospectively evaluated outcomes of 59 patients with LMLBO. We compared the outcomes of 26 patients with CMS for LMLBO between 2013 and 2015 (CMS group) with those of 33 patients managed with TDT between 2003 and 2011 (TDT group) by the historical study. LMLBO was defined as a large bowel obstruction due to a colorectal cancer that was diagnosed by computed tomography and required emergent decompression.ResultsAll patients in the CMS group were successfully decompressed (p = 0.03) and could initiate oral intake after the procedure (p < 0.01). Outcomes in the CMS group were superior to the TDT group in the following areas: duration of tube placement (p < 0.01), surgical approach (p < 0.01), operation time (p < 0.01), number of resected lymph nodes (p < 0.001), and rate of curative resection (p < 0.01). However, no significant differences were found in the overall postoperative complication rate (p = 0.151), surgical site infection rate (p = 0.685), hospital length of stay (p = 0.502), and the need for permanent ostomy (p = 0.745). The 3-year overall survival rate of patients in the CMS and TDT groups was 73.0% and 80.9%, respectively, and this was not significant (p = 0.423).ConclusionsTreatment with CMS for patients with LMLBO as a bridge to surgery is safe and demonstrated higher rates of resumption of solid food intake and temporary discharge prior to elective surgery compared to TDT. Oncological outcomes during mid-term were equivalent.

Self-expanding metal stent insertion by colorectal surgeons using a two-person approach colonoscopy without fluoroscopic monitoring in the management of acute colorectal obstruction: a 14-year experience

“…It was consistent with most of the evidences and experiences that an interval of over 15 days can minimize postoperative complications. This treatment strategy was used in all patients presenting with ACO in our center instead of using anal tube decompression as reported [ 33 ].…”

Comparison of survival and perioperative outcome of the colonic stent and the transanal decompression tube placement and emergency surgery for left-sided obstructive colorectal cancer: a retrospective multi-center observational study “The CODOMO study”

“…Although TADT is considered to have a negative impact on QOL, the expenses of TADT is much lower than that of SEMS. For these reasons, TADT has been used as a procedure of BTS in some Asian countries [ 32 , 33 ]. In a meta-analysis comparing the success rates, both technical and clinical success rates were significantly better for SEMS than for TADT [ 6 ].…”

“…The postoperative hospital stay was shorter with SEMS, but the difference did not reach significance. In terms of long-term outcomes, the 5-year DFS of stage II and III was reported to be 72.2% for SEMS and 52.0% for TADT [ 33 ].…”

Emergency Management of Obstructive Colorectal Cancer – A Retrospective Study of Efficacy and Safety in Self-expanding Metallic Stents and Trans-anal Tubes

“…Stoma creation is permanent in up to 40% of patients, and significantly reduces the patients' quality of life (QOL) (9, 10). In order to avoid emergency surgery and permanent stoma creations, various types of procedures, such as temporary stoma, trans-anal tube (TAT), and self-expanding metallic stent (SEMS), are used (11,12).Recently, elective surgery has been selected more frequently than emergency primary tumor resection (ER). SEMS was introduced as a palliative treatment measure for OCRC in patients with incurable disease (13, 14) and as a bridge to surgery (BTS) (15,16) in the 1990s.…”

“…Stoma creation is permanent in up to 40% of patients, and significantly reduces the patients' quality of life (QOL) (9, 10). In order to avoid emergency surgery and permanent stoma creations, various types of procedures, such as temporary stoma, trans-anal tube (TAT), and self-expanding metallic stent (SEMS), are used (11,12).…”