Long‐term outcomes between self‐expandable metallic stent and transanal decompression tube for malignant large bowel obstruction: A multicenter retrospective study and meta‐analysis

Abstract

Aim To compare the oncological outcomes between self‐expandable metallic stent (SEMS) as a bridge to surgery and transanal decompression tube (TDT) placement for malignant large bowel obstruction (MLBO). Methods A total of 287 MLBO patients who underwent SEMS (n = 137) or TDT placement (n = 150) were enrolled in this multicenter retrospective study. Overall survival (OS) and disease‐free survival (DFS) between the two groups were compared. A meta‐analysis was performed using random‐effects models to calculate odd ratios (OR) with 95% confidence intervals (CIs). Results Postoperative complications of Clavien–Dindo grade ≥II and ≥III occurred frequently in the TDT group compared with the SEMS group (P = 0.002 and 0.005, respectively). The 3‐y OS in the overall cohort and 3‐y DFS in the pathological stage II/III cohort in the SEMS and TDT groups were 68.6% and 71.4%, and 71.0% and 72.6%, respectively. The survival differences were not significantly different in the OS and DFS analyses (P = 0.819 and P = 0.892, respectively). A meta‐analysis of nine studies (including our cohort data) demonstrated no significant difference between the SEMS and TDT groups for 3‐y OS and DFS (OR = 0.96, 95% CI = 0.57–1.62, P = 0.89 and OR = 0.69, 95% CI = 0.46–1.04, P = 0.07, respectively). Conclusion Our study demonstrated that SEMS placement had no inferiority regarding long‐term outcomes, including OS and DFS, compared with TDT placement. Considering the short‐term benefits of SEMS placement, this could be a preferable preoperative decompression method for MLBO.

Short-term and long-term oncologic outcomes of self-expandable metallic stent compared with tube decompression for obstructive colorectal cancer: a systematic review and meta-analysis

“…Twenty studies evaluated perioperative short-term outcomes [ 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 ]. Nine studies evaluated 3-year OS [ 18 19 20 21 22 26 30 31 32 ], and 12 studies evaluated 3-year RFS [ 10 11 12 13 14 15 17 18 21 22 23 24 ]. All studies determining OS and RFS evaluated patients with stage II or III colorectal cancers.…”

“…One study evaluated patients with right-sided obstructive colorectal cancers [ 31 ]. Eight studies evaluated patients with both right- and left-sided obstructive colorectal cancers [ 18 19 21 26 29 30 34 37 ]. Evaluation of methodological quality showed all studies scored 6 points on the NOS.…”

“…There have been studies including meta-analyses to determine perioperative short-term outcomes and long-term oncologic outcomes of SEMS compared with TD. However, to our knowledge, these previous meta-analyses are missing studies and data on these outcomes [ 18 38 39 40 ]. Therefore, we searched studies and collected data more comprehensively, and we performed a meta-analysis of these data regarding preoperative and postoperative outcomes, along with survival outcomes such as 3-year OS and 3-year RFS.…”

Large Bowel Obstruction: Etiologies, Diagnosis, and Management

“…25 SEMS followed by resection has shown equivalent long-term outcomes (3year overall and disease-free survival) compared with immediate surgery. 24,26,27 For LBO of any etiology, ischemia, peritonitis, and perforation are associated with significantly higher mortality (up to 50%). 28 For this reason, decisive surgical intervention is needed to prevent these complications.…”

“…25 SEMS followed by resection has shown equivalent long-term outcomes (3-year overall and disease-free survival) compared with immediate surgery. 24 26 27…”