Endo‐laparoscopic approach versus conventional open surgery in the treatment of obstructing left‐sided colon cancer: Long‐term follow‐up of a randomized trial

Abstract

Introduction: We previously conducted a randomized trial comparing the endo-laparoscopic approach (i.e. placing self-expanding metallic stents followed by laparoscopic resection) and conventional open surgery in the treatment of obstructing left-sided colon cancer. This study is a follow-up of the previous randomized trial and aims to report the long-term outcomes of the two groups. Methods: Forty-eight patients from the randomized trial were followed up in an outpatient clinic with regular monitoring. Patients were compared for clinicopathological variables, disease recurrence and survival rates.Results: Clinicopathological details were comparable between the two groups. During the median follow-up periods of 32 months for the open group and 65 months endo-laparoscopic group, no statistically significant difference was observed between the groups in disease recurrence rate, 5-year overall survival (27% vs 48%, P = 0.076) and 5-year disease-free survival rates (48% vs 52%, P = 0.63). Conclusion: Besides being a safe bridge to subsequent elective laparoscopic surgery, preoperative self-expanding metallic stents insertion does not adversely affect oncological outcomes and patient survival. Based on our data, the endo-laparoscopic approach is the treatment of choice for patients presenting with malignant left-sided colonic obstruction.

Stent as bridge to surgery for left-sided malignant colonic obstruction reduces adverse events and stoma rate compared with emergency surgery: results of a systematic review and meta-analysis of randomized controlled trials

“…Sabbagh et al 9 showed that overall survival was significantly lower in the SBTS group (25% vs 62%, P Z .0003) and when only patients with no perforation and no metastasis on diagnosis were considered. The studies by Alcántara et al, 19 Tung et al, 27 and Arezzo et al 21 did not confirm these data, however; the meta-analysis by Matsuda et al 28 also showed no significant difference between SBTS and ES in terms of overall survival, disease-free survival, and recurrence. Sloothaak et al, 29 in their analysis of the long-term results of the Stent-in-2 trial, reported that stent placement was associated with a higher risk of recurrence but that the numbers were too small to draw a definitive conclusion.…”

Resultados del uso de stent metálico autoexpandible como terapia puente en cáncer de colon izquierdo obstructivo

“…En esta serie de casos se logró resecar más de 12 linfonodos en el 100% de nuestros pacientes con una mediana de 41. Existen reportes que han demostrado que transformando la cirugía en electiva de esta manera, se logra recolectar un mayor número de linfonodos, comparado a la cirugía de urgencia 14,18 . Tung y colaboradores presentan una mediana de 23 linfonodos en cirugía con stent versus 11 linfonodos en cirugía de urgencia, con un p significativo 18 .…”

“…Tung y colaboradores en un trabajo prospectivo, randomizado, compararon pacientes estadio II y III, sometidos a resección curativa en cáncer de colon obstructivo, no encontrando diferencias significativas en sobrevida a 5 años al comparar los grupos (42,8% en cirugía de urgencia versus 57,1% en cirugía con stent, con un p = 0,347) 18 . Resultado similar muestra Zhang en su metaanálisis publicado el año 2012, así como un reciente trabajo randomizado múlticéntrico 8,17 .…”

Colonic cancer: The current role of stent insertion

“…15 This guideline is based on the evidence from eight systematic reviews with meta-analysis comparing preoperative stenting with emergency resection for left-sided colonic malignant obstruction, 11,[36][37][38][39][40][41][42] with assimilated data from up to seven RCTs. [43][44][45][46][47][48][49] Three of those RCTs were closed early due to adverse outcomes in the SEMS group (higher 30-day morbidity related to stent perforation), 43,44 or high anastomotic leak rate in the emergency surgery group. 48 The most recently published meta-analysis found that SEMS as a bridge to surgery (n = 195) compared to emergency surgery (n = 187) had a lower overall morbidity (33.1% vs 53.9%, P = 0.03), a higher successful primary anastomosis rate (67.2% vs 55.1%, P < 0.01), and a lower permanent stoma rate (9% vs 27.4%, P < 0.01); however, there was no statistical difference in post-operative mortality (10.7% vs 12.4%).…”