Oncological outcome of malignant colonic obstruction in the Dutch Stent-In 2 trial

Sloothaak, D.A.M.; Berg, Maartje M. van den; Tanis, Pieter J.; Hooft, Jeanin E. van; Fockens, Paul; Bemelman, Willem A.; Dijkgraaf, Marcel G. W.; Sprangers, Mirjam A. G.; Buskens, C J; Jansen, Jeroen M.; Gerhards, M. F.; Timmer, Robin; Ramshorst, Bert van; Oldenburg, Bas; Hilligersberg, Richard van; Bakker, C. M.; Sosef, Meindert N.; Witteman, P; Kruyt, Philip M.; Hove, W. Rogier ten; Tseng, L. N. L.; Linde, K; Koopal, Sietze A.; Marinelli, A.; Perk, LE; Holzik, M F Lutke; Grubben, M.J.A.L.; Heisterkamp, Joos; Depla, A.C.T.M.; Derksen, Eric; Naber, A.H.J.; Geloven, Anna Aw van; Breumelhof, R.; Davids, P. H. P.; Akol, Halil; Zaag, Edwin van der; Schenk, Ed; Patijn, Gijsbert A.; Veenendaal, R. A.; Tollenaar, R.A.E.M.; Berkel, Anne-Marie van; Gilissen, Lennard P L; Nieuwenhuijzen, G.A.P.; Waaij, Laurens A. van der; Baas, Peter C.; Cense, Huib A.; Scholten, Pieter; Wagensveld, Bart A. van; Koornstra, Jan J.; Havenga, Klaas; Wit, M van Milligen de; Rijken, Arjen M.; Cazemier, M.; Guicherit, Onno R.; Houben, Mhmg; Steup, Willem-Hans

doi:10.1002/bjs.9645

Cited by 204 publications

(175 citation statements)

References 23 publications

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“…While colonic self-expanding metallic stents may offer an effective treatment option in patients with OCRC, however, it has also been reported that stent placement for OCRC was associated with the risk of recurrence. 21 Therefore, the efficacy of colonic self-expanding metallic stents remains controversial.…”

Section: Discussionmentioning

confidence: 99%

Effect of Preoperative Colonic Drainage for Obstructing Colorectal Cancer

Kochi

Fujii

Hagiwara

et al. 2015

International Surgery

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Obstructing colorectal cancer (OCRC) is believed to indicate poorer long-term survival. The purpose of this study was to compare retrospectively perioperative safety and longterm results in patients undergoing surgery for OCRC following preoperative colonic decompression with that in those undergoing elective surgery alone for nonobstructing colorectal cancer (CRC). A total of 656 consecutive CRC patients undergoing colectomy between 2001 and 2011 at our institute were eligible for inclusion in the study. The patients were divided into an OCRC group, which included 104 patients undergoing colectomy with preoperative colonic decompression, and a CRC group, which included 552 patients undergoing colectomy alone. Morbidity, mortality, and prognosis were assessed. In the OCRC group, decompression was performed by nasointestinal tube in 42 patients (40.4%), transanal tube in 15 (14.4%), and colostomy in 47 (45.2%). The mortality rate was 0% in the OCRC group and 0.4% in the CRC group (2 of 552 patients). The morbidity rate was 44.8% in the OCRC group (48 of 104 patients) and 36.6% in the CRC group (202 of 552 patients). The 5-year overall survival rate was 69.5% in the OCRC group and 72.9% in the CRC group [hazard ratio 0.76; 95% confidence interval, 0.35 to 1.16; P ¼ 0.48)]. No statistically significant difference in survival was observed between the 2 groups in stage II, III, or IV, or overall. No difference was observed in safety or survival between advanced OCRC patients undergoing preoperative colonic decompression and advanced non-obstructing CRC patients undergoing surgery alone. While some studies have reported that OCRC has a poorer prognosis than nonobstructing CRC, 4,5 others have found no difference. 6,7 This poses a problem in the surgical management of OCRC.In many institutions, 1-stage primary resection is recommended for OCRC, as this allows colostomy and further nonsurgical drainage for the obstruction to be avoided. [8][9][10] On the other hand, disruption of anastomosis was observed in more than 50% of cases in which resection was performed as initial surgery without surgical or nonsurgical decompression for the obstruction, threatening overall deterioration in the patient's condition.Therefore, some have recommended decompression as a means of avoiding this problem. 11However, the effectiveness of surgical or nonsurgical decompression for OCRC remains controversial.Since January 2001, we have performed preoperative decompression in all OCRC patients to reduce the rate of surgical complications and hospital death.The purpose of this study was to compare retrospectively perioperative safety and long-term results in patients undergoing elective surgery for advanced OCRC after preoperative colonic decompression with that in patients undergoing elective surgery alone for advanced nonobstructing CRC. Materials and Methods Patient population and methodsBetween January 2001 and December 2011, a total of 879 consecutive stage I-IV colorectal cancer patients underwent colectomy for primary histologically pr...

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Section: Discussionmentioning

confidence: 99%

Effect of Preoperative Colonic Drainage for Obstructing Colorectal Cancer

Kochi

Fujii

Hagiwara

et al. 2015

International Surgery

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“…12,46,48 Sloothaak et al 12 reanalyzed the largest data set (from the Stent-In-2 trial in 2014). They excluded the benign cases and those with advanced disease (palliative).…”

Section: Sems As a Bridge To Elective Surgerymentioning

confidence: 99%

“…Cumulative incidence of overall disease recurrence was 26% in the surgery group, 34% in the unperforated SEMS group and 83% in the perforated SEMS group (P < 0.01). 12 The concern therefore is that short-term gains would be negated by poorer long-term outcomes. If true, this would be an inappropriate trade off in patients fit enough to undergo surgery in whom the intent is curative.…”

Section: Sems As a Bridge To Elective Surgerymentioning

confidence: 99%

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Colonic cancer: The current role of stent insertion

Newton

Hill

2017

Int J Gastrointest Interv

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Acute colonic obstruction secondary to left-colonic malignancy remains a common emergency condition. Traditional management is emergency surgery and has high morbidity and mortality. Self expandable metallic stents (SEMS) promised to improve morbidity and mortality, stoma rates and hospital stay. SEMS use in the potentially curative setting, as a bridge to surgery, is associated with an improved stoma rate and morbidity, but has no mortality benefit. There are concerns about oncological safety with higher local recurrence rates, thus SEMS is not recommended in this setting unless the patient has increased surgical risk and would benefit from a period of recovery prior to surgery. SEMS has a definite role in the palliative setting, for both patients with incurable disease or those with a high surgical risk. SEMS is associated with improved morbidity, mortality, and stoma rates. The technique for SEMS insertion is now well established but it is still unclear whether covered or uncovered stents are better.

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“…Malgras showed an increased metastatic process and shorter survival time in a mouse model of colonic cancer treated with SEMS [14] . Besides in the last decade many studies have been published, including randomized controlled trials (RCTs) and systematic reviews, with conflicting results comparing SEMS as BTS and emergency surgery in terms of safety, morbidity, disease free survival (DFS), recurrence rate and overall survival (OS) [15][16][17][18][19][20] . Actually surgeons are not allowed to consider CS as BTS for young and potentially curable patients.…”

Section: Introductionmentioning

confidence: 99%

Colonic Stenting in the Management of Acute Left-sided Malignant Colonic Obstruction is Oncologically Safe?

Belinda

Catena

2017

Journal of Tumor

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stoma creation in comparison with emergency surgery, enhancing patients' quality of life, without differences in terms of mortality and morbidity rate. According to available data, at one year follow up time, the recurrence rate is higher in patients treated with stent, with no statistical difference in terms of disease free survival and overall survival. Endoscopist's experience, type of colic obstruction (partial or total), type of stent, insertion technique and timing of surgery are fundamental to reach CS technical and clinical success. Oncologic (un)-safety of colonic stenting has to be still investigated and confirmed by medium and long term follow up of large prospective studies and randomized controlled trials comparing SEMS as bridge to surgery and ES. CS can be strongly considered with palliative intent in patients with advanced neoplastic disease, to avoid stoma and health care costs related to stoma.

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Oncological outcome of malignant colonic obstruction in the Dutch Stent-In 2 trial

Abstract: ISRCTN46462267 ( http://www.controlled-trials.com).

Cited by 204 publications

References 23 publications

Effect of Preoperative Colonic Drainage for Obstructing Colorectal Cancer

Effect of Preoperative Colonic Drainage for Obstructing Colorectal Cancer

Colonic cancer: The current role of stent insertion

Colonic Stenting in the Management of Acute Left-sided Malignant Colonic Obstruction is Oncologically Safe?

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