Comparison of the prognosis of four different treatment strategies for acute left malignant colonic obstruction: a systematic review and network meta-analysis

Tan, Ling; Liu, Zilin; Ran, Mengni; Tang, Lixia; Pu, Yan-Jun; Liu, Yi-Lei; Ma, Zhou; Zhou, He; Xiao, Jiangwei

doi:10.1186/s13017-021-00355-2

Cited by 16 publications

(5 citation statements)

References 80 publications

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“…Although long-term oncological outcomes seem at least comparable between both BTS strategies and acute resection, reports on short-term outcomes have suggested important differences between the 3 treatment options. 9,12,[14][15][16][17][18] Regarding short-term mortality, the current study demonstrates a risk reduction when performing DS as BTS compared with acute resection, whereas this was not observed for SEMS as BTS. This was also found in a recent systematic review, in which no reduction in mortality was observed in the SEMS as BTS group compared to the emergency surgery group.…”

Section: Discussionmentioning

confidence: 50%

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Predicting Mortality Within 90 Days of First Intervention in Patients With Left-Sided Obstructive Colon Cancer

Burghgraef

Bakker

Veld

et al. 2022

Diseases of the Colon &Amp; Rectum

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BACKGROUND:Acute resection for left-sided obstructive colon carcinoma is thought to be associated with a higher mortality risk than a bridge-to-surgery approach using decompressing stoma or self-expandable metal stent, but prediction models are lacking. OBJECTIVE:This study aimed to determine the influence of treatment strategy on mortality within 90 days from the first intervention in patients presenting with leftsided obstructive colon carcinoma.DESIGN: This was a national multicenter cohort study that used data from a prospective national audit. SETTINGS:The study was performed in 75 Dutch hospitals.PATIENTS: Patients were included if they underwent resection with curative intent for left-sided obstructive colon carcinoma between 2009 and 2016. INTERVENTIONS:First intervention was either acute resection, bridge to surgery with self-expandable metallic stent, or bridge to surgery with decompressing stoma. MAIN OUTCOME MEASURES:The main outcome measure was 90-day mortality after the first intervention. Risk factors were identified using multivariable logistic analysis. Subsequently, a risk model was developed. RESULTS:In total, 2395 patients were included, with the first intervention consisting of acute resection in 1848 patients (77%), stoma as bridge to surgery in 332 patients (14%), and stent as bridge to surgery in 215 patients Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal's website (www.dcrjournal.com).

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Section: Discussionmentioning

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Predicting Mortality Within 90 Days of First Intervention in Patients With Left-Sided Obstructive Colon Cancer

Burghgraef

Bakker

Veld

et al. 2022

Diseases of the Colon &Amp; Rectum

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“…Endoscopic SEMS placement for CCIO is safe and provides an opportunity for further treatment [6]. After stent placement, performing adequate preoperative evaluation of the patients for the treatment option is possible, which can signi cantly reduce the stoma rate [4,5,8,12]. It also has a signi cantly lower complication rate than emergency surgery [13][14][15].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of the combined application of ultrathin endoscope and guidewire replacement for self-expandable metal stent placement in colorectal carcinoma with intestinal obstruction: A retrospective analysis

Shu

Chen

et al. 2023

Preprint

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Background: Self-expandable metal stent (SEMS) placement with an emergency colonoscope has been gradually applied to treat colorectal carcinoma with intestinal obstruction (CCIO). We proposed a new technique based on current SEMS placement with the combined application of ultrathin endoscope and guidewire replacement to solve previous technical difficulties. This study evaluated its feasibility, efficacy, and safety for SEMS placement in CCIO. Methods: We retrospectively analyzed data of 31 CCIO patients, who received the novel SEMS placement technique at Wuhan No.1 Hospital between June 2019 and October 2022. Technical and clinical success rates, adverse events, prognosis, and follow-up were evaluated. Inter-group differences between bridge to surgery (BTS) and palliative treatment (PT) groups and clinical feasibility of this technique were analyzed. Results: Overall technical and clinical success rates were 100% (31/31) and 96.8% (30/31), respectively, without adverse events. There was no significant difference in procedure time and technical/clinical success rates among three attending physicians(p>0.05). Fourteen BTS patients (14/31, 45.2%) underwent SEMS with a post-placement confined operation, which had a 100% success rate (14/14) and no ostomy. Median follow-up time was 67.5 days, and four patients (4/14, 28.6%) had postoperative adverse events of inflammatory anastomotic changes. Seventeen PT patients had a median follow-up time of 30 days, without adverse events. Two patients (2/17, 11.8%) underwent follow-up colonoscopywith no post-placement stent migration/obstruction. Conclusions: The combined application of ultrathin endoscope with guidewire replacement for SEMS placement to treat CCIO could avoid X-ray-induced medical radiation damage and reduce cross-infection risk, making it clinically safe, effective, and promotion suitable.

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“…As a bridge to elective surgery, SEMS and stoma creation offer better short-term and long-term outcomes compared to emergency resection. The difference concerns primarily the percentage of primary anastomoses, as well as postoperative complications, perioperative mortality and long-term results of treatment [ 96 , 132 , 133 ]. Maintaining high efficiency of the method requires extensive experience from the endoscopist.…”

Section: Bowel Obstructionmentioning

confidence: 99%

The Association of Polish Surgeons (APS) clinical guidelines for the use of laparoscopy in the management of abdominal emergencies. Part II.

Sobocki¹,

Pędziwiatr²,

Bigda³

et al. 2023

Videosurgery and Other Miniinvasive Techniques

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Introduction Over the past three decades, almost every type of abdominal surgery has been performed and refined using the laparoscopic technique. Surgeons are applying it for more procedures, which not so long ago were performed only in the classical way. The position of laparoscopic surgery is therefore well established, and in many operations it is currently the recommended and dominant method. Aim The aim of the preparation of these guidelines was to concisely summarize the current knowledge on laparoscopy in acute abdominal diseases for the purposes of the continuous training of surgeons and to create a reference for opinions. Material and methods The development of these recommendations is based on a review of the available literature from the PubMed, Medline, EMBASE and Cochrane Library databases from 1985 to 2022, with particular emphasis on systematic reviews and clinical recommendations of recognized scientific societies. The recommendations were formulated in a directive form and evaluated by a group of experts using the Delphi method. Results and conclusions There are 63 recommendations divided into 12 sections: diagnostic laparoscopy, perforated ulcer, acute pancreatitis, incarcerated hernia, acute cholecystitis, acute appendicitis, acute mesenteric ischemia, abdominal trauma, bowel obstruction, diverticulitis, laparoscopy in pregnancy, and postoperative complications requiring emergency surgery. Each recommendation was supported by scientific evidence and supplemented with expert comments. The guidelines were created on the initiative of the Videosurgery Chapter of the Association of Polish Surgeons and are recommended by the national consultant in the field of general surgery. The second part of the guidelines covers sections 6 to12 and the following challenges for surgical practice: acute appendicitis, acute mesenteric ischemia, abdominal injuries, bowel obstruction, diverticulitis, laparoscopy in pregnancy and postoperative complications requiring a reoperation.

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Comparison of the prognosis of four different treatment strategies for acute left malignant colonic obstruction: a systematic review and network meta-analysis

Cited by 16 publications

References 80 publications

Predicting Mortality Within 90 Days of First Intervention in Patients With Left-Sided Obstructive Colon Cancer

Predicting Mortality Within 90 Days of First Intervention in Patients With Left-Sided Obstructive Colon Cancer

Outcomes of the combined application of ultrathin endoscope and guidewire replacement for self-expandable metal stent placement in colorectal carcinoma with intestinal obstruction: A retrospective analysis

The Association of Polish Surgeons (APS) clinical guidelines for the use of laparoscopy in the management of abdominal emergencies. Part II.

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