Obstructing Left-Sided Colonic Cancer: Is Endoscopic Stenting a Bridge to Surgery or a Bridge to Nowhere?

Lauro, Augusto; Binetti, Margherita; Vaccari, Samuele; Cervellera, Maurizio; Tonini, Valeria

doi:10.1007/s10620-020-06403-2

Cited by 13 publications

(15 citation statements)

References 92 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In contrast, several trials showed that SEMS placement as a bridge to elective surgery did not improve the survival rates [17][18][19][20]. How SEMS placement worsens prognostic outcomes remains unclear [21,22].…”

mentioning

confidence: 99%

Bridge to surgery using a self-expandable metallic stent for stages II–III obstructive colorectal cancer

et al. 2020

View full text Add to dashboard Cite

Background: Bridge to surgery (BTS) using a self-expandable metallic stent (SEMS) for the treatment of obstructive colorectal cancer improves the patient's quality of life. This study aimed to examine prognostic factors of obstructive colorectal cancer. Methods: We analyzed stage II-III resectable colon cancer cases (Cur A) retrospectively registered between January 2005 and December 2017. Overall, 117 patients with Cur A obstructive colorectal cancer were evaluated: 67 of them underwent emergency surgery (ES Group) and 50 of them after BTS with SEMS placement (BTS group). We compared surgical results and prognoses between the two groups. Results: A total of 50 patients underwent endoscopic SEMS placement, which technical success of 96% and morbidity rate of 18%. Primary anastomosis rates were 77.6% in ES and 95.7% in BTS (p < 0.001); postoperative complication, 46.3% in ES and 10.5% in BTS (p < 0.001); pathological findings of lymphatic invasion, 66.7% in ES and 100% in BTS (p < 0.001); venous invasion were 66.8% in ES and 92% in BTS (p = 0.04); and recurrence of 25.4% in ES and 39.1% in BTS. The 3-year overall survival was significantly different between two groups (ES, 86.8%:BTS, 58.8%), BTS is worse than ES (log-rank test; p < 0.001). Venous invasion independently predicted worsened recurrence-free and overall survival. Conclusions: The vascular invasiveness was correlated with tumor progression after SEMS placement, and the survival rate was lower in BTS. SEMS potentially worsens prognostic outcomes in stage II-III obstructive colorectal cancer.

show abstract

mentioning

confidence: 99%

Bridge to surgery using a self-expandable metallic stent for stages II–III obstructive colorectal cancer

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Overall survival (OS) and disease-free survival (DFS) are the most commonly used indicators to evaluate the prognosis of cancer patients. A recent literature review showed that only a small number of studies showed that the placement of SEMS may affect the long-term surgical outcomes, and most studies showed that SEMS did not have a negative impact on the patients’ long-term survival and prognosis [ 59 ]. Two recent meta-analyses respectively summarize the data of 2508 patients and 15,224 patients, the results showed no significant difference between SEMS and ES in terms of three-year OS and three-year DFS, or five-year OS and five-year DFS, which was consistent with the results of previous meta-analysis [ 59 – 61 ].…”

Section: Discussionmentioning

confidence: 99%

“…A recent literature review showed that only a small number of studies showed that the placement of SEMS may affect the long-term surgical outcomes, and most studies showed that SEMS did not have a negative impact on the patients’ long-term survival and prognosis [ 59 ]. Two recent meta-analyses respectively summarize the data of 2508 patients and 15,224 patients, the results showed no significant difference between SEMS and ES in terms of three-year OS and three-year DFS, or five-year OS and five-year DFS, which was consistent with the results of previous meta-analysis [ 59 – 61 ]. However, given the relatively small proportion of randomized controlled studies (20.8% and 26.7% respectively), and the factors such as stent placement technology and stent type can not be standardized, and due to the possible influence of factors such as chemotherapy and surgical interval mentioned above, the absence of significant differences in long-term surgical outcomes should be interpreted with caution.…”

Section: Discussionmentioning

confidence: 99%

Comparison of safety between self-expanding metal stents as a bridge to surgery and emergency surgery based on pathology: a meta-analysis

Fan

et al. 2020

BMC Surg

View full text Add to dashboard Cite

Background To explore the long-term oncological safety of using self-expanding metal stents (SEMS) as a bridge to surgery for acute obstructive colorectal cancer by comparing the pathological results of emergency surgery (ES) with elective surgery after the placement of SEMS. Methods Studies comparing SEMS as a bridge to surgery with emergency surgery for acute obstructive colorectal cancer were retrieved through the databases of Pubmed, Embase, and Cochrane libraries, and a meta-analysis was conducted based on the pathological results of the two treatments. Risk ratios (OR) or mean differences (MD) with 95% confidence intervals (CI) were calculated for the outcomes under random effects model. Results A total of 27 studies were included, including 3 randomized controlled studies, 2 prospective studies, and 22 retrospective studies, with a total of 3737 patients. The presence of perineural invasion (RR = 0.58, 95% CI 0.48, 0.71, P < 0.00001), lymphovascular invasion (RR = 0.68, 95% CI 0.47, 0.99, P = 0.004) and vascular invasion (RR = 0.66, 95% CI 0.45, 0.99, P = 0.04) in SEMS group were significantly higher than those in ES group, and there was no significant difference in lymphatic invasion (RR = 0.92, 95% CI 0.77, 1.09, P = 0.33). The number of lymph nodes harvested in SEMS group was significantly higher than that in ES group (MD = − 3.18, 95% CI − 4.47, − 1.90, P < 0.00001). While no significant difference was found in the number of positive lymph nodes (MD = − 0.11, 95% CI − 0.63, 0.42, P = 0.69) and N stage [N0 (RR = 1.03, 95% CI 0.92, 1.15, P = 0.60), N1 (RR = 0.99, 95% CI 0.87, 1.14, P = 0.91), N2 (RR = 0.94, 95% CI 0.77, 1.15, P = 0.53)]. Conclusions SEMS implantation in patients with acute malignant obstructive colorectal cancer may lead to an increase in adverse tumor pathological characteristics, and these characteristics are mostly related to the poor prognosis of colorectal cancer. Although the adverse effect of SEMS on long-term survival has not been demonstrated, their adverse effects cannot be ignored. The use of SEMS as the preferred treatment for patients with resectable obstructive colorectal cancer remains to be carefully weighed, especially when patients are young or the surgical risk is not very high.

show abstract

“…The use of a self‐expanding metal stent as a bridge to surgery (BTS) in patients with acute malignant large bowel obstruction is considered a reasonable strategy 1 . Unlike emergency surgery, decompression with a self‐expanding metal stent allows time for medical stabilization, including correction of dehydration and electrolyte imbalances, and for improving comorbidities or obstructive enteritis; this can potentially reduce morbidity, mortality, and the need for a stoma 2 . Recent studies have shown that BTS, compared with emergency surgery, actually improves short‐term outcomes and the stoma rate in patients with colorectal cancer (CRC) and obstruction, without differences in long‐term outcomes 3–6 .…”

Section: Introductionmentioning

confidence: 99%

“…1 Unlike emergency surgery, decompression with a self-expanding metal stent allows time for medical stabilization, including correction of dehydration and electrolyte imbalances, and for improving comorbidities or obstructive enteritis; this can potentially reduce morbidity, mortality, and the need for a stoma. 2 Recent studies have shown that BTS, compared with emergency surgery, actually improves short-term outcomes and the stoma rate in patients with colorectal cancer (CRC) and obstruction, without differences in long-term outcomes. [3][4][5][6] Given these data, the European Society for Gastrointestinal Endoscopy (ESGE) has reconsidered its stance on colonic stenting as a BTS and now recommends it, in its 2020 guideline, as a valid alternative to emergency surgery.…”

mentioning

confidence: 99%

What are the factors predictive of postoperative complications in patients with colorectal cancer undergoing stenting as a bridge to surgery?

Adachi

Tokunaga

Matsumoto

et al. 2022

Journal of Surgical Oncology

View full text Add to dashboard Cite

Objective Using a self‐expanding metal stent as a bridge to surgery (BTS) is considered a reasonable strategy for patients with acute malignant large bowel obstruction. Since postoperative complications have a negative impact on patient survival, we aim to clarify the predictors of complications in patients undergoing BTS using a self‐expanding metal stent. Methods We conducted a retrospective review of 61 patients with colorectal cancer (CRC) who underwent stenting as a BTS at our institution. We analyzed the association of postoperative complications with clinicopathologic, surgical, and patient factors, and with the prestenting or preoperative laboratory data. Results Both postoperative complications in general and severe complications were significantly associated with a longer stenotic‐section length (p = 0.007 and p = 0.003), lower preoperative hemoglobin levels (p < 0.001 and p = 0.081), and lower prestenting hemoglobin levels (p = 0.006 and p = 0.042). Multivariate logistic regression analysis showed that lower prestenting (<13.0 g/dl) and preoperative (<11.5 g/dl) hemoglobin levels were independent predictive factors for postoperative complications (odds ratio [OR]: 4.15; 95% confidence interval [CI]: 1.07–18.90; p = 0.040; and OR: 4.93; 95% CI: 1.35–20.28; p = 0.016). A stenotic‐section length of 5.0 cm or greater was predictive of severe complications (OR: 25.67; 95% CI: 1.95–1185.00; p = 0.011). Conclusions Our data suggest that lower hemoglobin levels before stenting and a longer length of the stenotic section of bowel might predict postoperative complications in patients with CRC undergoing BTS for obstruction.

show abstract

Obstructing Left-Sided Colonic Cancer: Is Endoscopic Stenting a Bridge to Surgery or a Bridge to Nowhere?

Cited by 13 publications

References 92 publications

Bridge to surgery using a self-expandable metallic stent for stages II–III obstructive colorectal cancer

Bridge to surgery using a self-expandable metallic stent for stages II–III obstructive colorectal cancer

Comparison of safety between self-expanding metal stents as a bridge to surgery and emergency surgery based on pathology: a meta-analysis

What are the factors predictive of postoperative complications in patients with colorectal cancer undergoing stenting as a bridge to surgery?

Contact Info

Product

Resources

About