Early surgery after bridge-to-surgery stenting for malignant bowel obstruction is associated with better oncological outcomes

Lim, Tammy; Tham, Hui Yu; Yaow, Clyve Yu Leon; Tan, Ian Jse-Wei; Chan, Douglas S.; Farouk, Ridzuan; Lee, Kuok Chung; Lieske, Bettina; Tan, Ker‐Kan; Chong, Choon Seng

doi:10.1007/s00464-020-08232-w

Cited by 10 publications

(8 citation statements)

References 25 publications

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“…Many studies have shown that SEMS placement does not decrease survival 7 , 15 – 17 , 21 . However, Sabbagh et al 22 noted that the SEMS group had a significantly worse overall survival than the ES group (25% vs. 62%, P = 0.0003).…”

Section: Discussionmentioning

confidence: 99%

A retrospective evaluation of short-term results from colonic stenting as a bridge to elective surgery versus emergency surgery for malignant colonic obstruction

Chongjing

Chen

2023

Sci Rep

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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.

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Section: Discussionmentioning

confidence: 99%

A retrospective evaluation of short-term results from colonic stenting as a bridge to elective surgery versus emergency surgery for malignant colonic obstruction

Chongjing

Chen

2023

Sci Rep

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“…However, in the present study, the interval from SEMS to resection was not associated with recurrence nor death according to univariate and multivariate logistic regression analysis. Lim et al reported that patients who underwent surgery within 2 weeks interval from SEMS placement had lower systemic recurrence rates after analyzing 53 patients [ 20 ]. Lastly, Sato et al reported an interval longer than 16 days was an independent risk factor for poor relapse-free survival.…”

Section: Discussionmentioning

confidence: 99%

“…Other studies reported no significant difference in the surgical approach according to bridging intervals. However, those studies showed a tendency for higher rates of open surgery in early surgery [ 20 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…In a previous study, a bridging interval of 5–10 days was associated with a higher stoma formation rate compared with a bridging interval >10 days [ 22 ]. Others reported that the bridging interval was not significantly associated with the stoma formation rate [ 20 ]. In the present study, the stoma formation rate was significantly higher in the patients who had a bridging interval of ≤ 2 weeks.…”

Section: Discussionmentioning

confidence: 99%

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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

Hong

Kim

et al. 2022

World J Surg Onc

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Background Self-expandable metal stent (SEMS) placement is commonly used as a bridge to surgery (BTS) for left-sided malignant colorectal obstruction (MCO). However, the optimal time interval between BTS stenting and surgery for left-sided MCO is unclear, and the results of previous studies are conflicting. This study aimed to determine the differences in clinical outcomes according to the time interval between BTS stenting and surgery in left-sided MCO. Methods Data from 594 patients who underwent SEMS placement for MCO between January 2009 and December 2018 were reviewed. Among them, 148 patients who underwent SEMS placement as BTS treatment and curative surgery were enrolled. The enrolled patients were divided into three groups according to the interval between BTS stenting and surgery: group 1 (interval ≤2 weeks), group 2 (interval 2–3 weeks), and group 3 (interval >3 weeks). Results Group 2 and 3 patients underwent significantly higher rates of laparoscopic surgery than those in group 1 (83.7, 81.0 vs. 53.2 %, respectively; P=0.003, P=0.003, respectively). Also, rates of stoma formation directly after resection were significantly higher in group 1 compared to groups 2 and 3 (21.3 vs 2.3, 6.9%, respectively; P=0.008, P=0.043, respectively). Bridging interval had no effect on SEMS-related complications, resection-related complications, 90-day mortality, permanent stoma formation, 3-year disease-free survival, and 3-year overall survival. Conclusions A bridging interval of > 2 weeks between BTS stenting and surgery for left-sided MCO is preferable for lower stoma formation rates and higher rates of laparoscopic approach operation, with no difference in short-term and long-term outcomes including complication, mortality, and survival.

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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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Early surgery after bridge-to-surgery stenting for malignant bowel obstruction is associated with better oncological outcomes

Cited by 10 publications

References 25 publications

A retrospective evaluation of short-term results from colonic stenting as a bridge to elective surgery versus emergency surgery for malignant colonic obstruction

A retrospective evaluation of short-term results from colonic stenting as a bridge to elective surgery versus emergency surgery for malignant colonic obstruction

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

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

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