Differences in clinical outcomes according to the time interval between the bridge to surgery stenting and surgery for left-sided malignant colorectal obstruction

Oh, Hee-Kyun; Hong, Jeongsoo; Kim, Dong-Hyun; Myung, Dae‐Seong; Cho, Sung-Bum; Lee, Wan‐Sik; Kim, Hyunsoo; Joo, Young‐Eun

doi:10.1186/s12957-022-02644-9

Cited by 4 publications

(3 citation statements)

References 22 publications

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“…A retrospective study showed a bridging interval of > 2 weeks between BTS SEMS placement and surgery for LMCO is favorable for short-term clinical outcomes. It can not only form a lower stoma rate but also have a higher rate of laparoscopic surgery (28). In general, a longer interval could compromise surgery by more local tumor infiltration and fibrosis.…”

Section: Discussionmentioning

confidence: 99%

Short-term effect of different time interval between self-expanding metallic stent and surgery for left-sided malignant colorectal obstruction

Zhang¹,

Su²,

Lin³

et al. 2022

Front. Gastroenterol.

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BackgroundThe optimal time interval between self-expanding metallic stent (SEMS) placement and surgery in patients with left-sided malignant colorectal obstruction (LMCO) remains controversial. Intestinal obstruction and SEMS placement would lead to intestinal edema, local tumor infiltration, and fibrosis, which may have a certain impact on elective surgery. Although prolong time interval would reduce relative complications, the risk of tumor progression must be taken into account. Therefore, our study proposes whether there is a difference in short-term postoperative complication outcomes between waiting for an interval of ≤4weeks compared with an extended interval for neoadjuvant chemotherapy followed by surgery.MethodsAll patients who underwent SEMS placement as BTS treatment for LMCO between January 2012 and December 2021 were retrospectively identified. The primary outcomes of this study were short-term clinical postoperative complications (Clavien-Dindo grading ≥II).ResultsOf the 148 patients, 70.27% of patients underwent surgery ≤4 weeks of SEMS placement (Group 1) while 29.73% of patients underwent surgery >4 weeks of SEMS placement (Group 2). After SEMS placement, the patients in Group 2 received neoadjuvant chemotherapy and then elective surgery. Significant differences were observed between both groups (Group 2 vs Group 1) for postoperative complications (Clavien-Dindo grading ≥II, 2.3% vs 14.4%, p=0.040), postoperative bowel function time (p<0.001), postoperative hospital stay (p=0.028) and total hospital stay (p=0.002).ConclusionsA bridging interval of >4 weeks between SEMS placement and surgery for LMCO has better short-term clinical outcome.

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Section: Discussionmentioning

confidence: 99%

Short-term effect of different time interval between self-expanding metallic stent and surgery for left-sided malignant colorectal obstruction

Zhang¹,

Su²,

Lin³

et al. 2022

Front. Gastroenterol.

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“…The later operation group demonstrated better 5-year recurrence-free survival (82.1% vs. 63.2%) and 5-year overall survival (75% vs. 51.4%). Recently, Oh et al 90 formed three groups based on the interval between SEMS use and operation (group 1 [≤2 weeks], group 2 [2–3 weeks], and group 3 [>3 weeks]). In this study, the bridging interval did not affect SEMS-related complications, resection-related complications, 90-day mortality, permanent stoma formation, 3-year disease-free survival, or 3-year overall survival.…”

Section: Optimal Timing Of Surgery After Colon Stentingmentioning

confidence: 99%

Colon stenting as a bridge to surgery in obstructive colorectal cancer management

Kim,

Lee

2024

Clin Endosc

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Colorectal cancer is one of the most common malignancies worldwide, and its prevalence is gradually increasing. 1,2 Large bowel obstruction caused by colorectal cancer occurs in 7% to 29% of patients with this cancer. [3][4][5] Conventionally, patients with obstructive colorectal cancer are treated with emergency surgery, which is associated with high morbidity and mortality Colonic stent placement is a commonly used bridging strategy for surgery in patients with obstructive colorectal cancer. The procedure involves the placement of a self-expandable metallic stent (SEMS) across the obstructive lesion to restore intestinal patency and alleviate the symptoms of obstruction. By allowing patients to receive surgery in a planned and staged manner with time for preoperative optimization and bowel preparation, stent placement may reduce the need for emergency surgery, which is associated with higher complication rates and poorer outcomes. This review focuses on the role of colon stenting as a bridge to surgery in the management of obstructive colorectal cancer. SEMS as a bridge to surgery for left-sided colon cancer has been demonstrated to be particularly useful; however, further research is needed for its application in cases of right-sided colon cancer. Colon stent placement also has limitations and potential complications including stent migration, re-obstruction, and perforation. However, the timing of curative surgery after SEMS placement remains inconclusive. Considering the literature to date, performing surgery at an interval of approximately 2 weeks is considered appropriate. Therefore, colonic stent placement may be an effective strategy as a bridge to surgery in patients with obstructive colorectal cancer.

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“…In this context, another discussed point is the “time to elective surgery,” which is the time between stent insertion and elective surgery[ 18 , 19 ]. Theoretically a delayed interval between SEMS placement and definitive surgery could allow better recovery and improve nutritional status, but it could be burdened by a high rate of local tumor infiltration and fibrosis[ 20 ].…”

Section: Guidelinesmentioning

confidence: 99%

Colonic stent for bridge to surgery for acute left-sided malignant colonic obstruction: A review of the literature after 2020

2022

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It has been found that 8%-29% of colorectal cancers are obstructive. The use of “stent as bridge to surgery” is one of the most debated topics in obstructive left-sided colorectal cancer management. The endoscopic placement of a self-expanding metallic stent as bridge to surgery (BTS) could turn an emergency surgery to an elective one, increasing the number of primary anastomoses instead of stoma and facilitating the laparoscopic approach instead of an open one. However, in recent years the possible risk of perforations and microperforations facilitating cancer spread related to the use of self-expanding metallic stent for BTS has been highlighted. Therefore, despite the useful short-term outcomes related to BTS, the recent literature has focused on long-term outcomes investigating the disease-free survival, the recurrence rate and the overall survival. Due to discordant data, international guidelines are still conflicting, and the debate is still open. There is not agreement about using self-expanding metallic stent for BTS as the gold standard.

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Differences in clinical outcomes according to the time interval between the bridge to surgery stenting and surgery for left-sided malignant colorectal obstruction

Cited by 4 publications

References 22 publications

Short-term effect of different time interval between self-expanding metallic stent and surgery for left-sided malignant colorectal obstruction

Short-term effect of different time interval between self-expanding metallic stent and surgery for left-sided malignant colorectal obstruction

Colon stenting as a bridge to surgery in obstructive colorectal cancer management

Colonic stent for bridge to surgery for acute left-sided malignant colonic obstruction: A review of the literature after 2020

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