Prospective, Controlled, Randomized Study of Intraoperative Colonic Lavage Versus Stent Placement in Obstructive Left‐sided Colonic Cancer

Alcántara, Manuel Jesús; Serra‐Aracil, Xavier; Falcó, Joan; Mora, Laura; Bombardó, J.; Navarro, Salvador

doi:10.1007/s00268-011-1139-y

Cited by 203 publications

(184 citation statements)

References 55 publications

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“…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%).…”

Section: Sems As a Bridge To Elective Surgerymentioning

confidence: 99%

“…[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%). This data suggests some advantages of SEMS use over emergency surgery, although with no difference in short-term mortality, the benefit of SEMS placement in this setting is less clear.…”

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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Section: Sems As a Bridge To Elective Surgerymentioning

confidence: 99%

Section: Sems As a Bridge To Elective Surgerymentioning

confidence: 99%

Colonic cancer: The current role of stent insertion

Newton

Hill

2017

Int J Gastrointest Interv

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“…Nous disposons de beaucoup de données sur les résul-tats des prothèses. Il s'agit en particulier de larges séries rétrospectives qui ont inclus au total 3 581 patients [13][14][15], de six études randomisées [16][17][18][19][20][21] et de sept méta-analyses [22][23][24][25][26][27][28]. À noter que ces méta-analyses s'appuient en partie sur des travaux rétrospectifs avec des objectifs pas toujours clairement définis.…”

Section: Succès Et Complications Des Endoprothèses à Court Termeunclassified

Place des prothèses coliques dans la stratégie thérapeutique du cancer colorectal

et al. 2014

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Messages• • Quelle que soit la situation, une discussion médicochirur-gicale doit avoir lieu avant toute décision thérapeutique.• • La pose d'une prothèse colique n'est pas recommandée en l'absence de signe clinique et radiologique d'occlusion, même lorsque la tumeur n'est pas franchissable par un endoscope. • • Si elle est indiquée, la pose de prothèse colique doit s'envisager dans les 12 à 24 heures suivant l'admission du patient. • • La prothèse colique est contre-indiquée en cas de perforation, de souffrance colique d'amont clinique et/ou radiologique, de cancer du bas et moyen rectum, d'occlusion du grêle par incarcération associée. • • La prothèse colique doit être mise en place par voie endoscopique et sous contrôle radiologique. • • La mise en place d'une prothèse colique doit être réali-sée par un opérateur entraîné et au sein d'une structure médico chirurgicale adaptée. • • L'utilisation de polyéthylène glycol (PEG) et d'autres préparations par voie orale est contre-indiquée. • • La dilatation préalable et le passage de la sténose tumorale par un endoscope de gros calibre sont à proscrire. • • En situation curative (tumeur non métastatique ou métas-tatique résécable, patient opérable), la prothèse colique ne peut pas être recommandée en première intention. Elle reste une option thérapeutique dans les centres experts, * Ces recommandations ont été publiées dans la revue Acta Endoscopica (2014) 4:208-18 Colon Rectum (2014) 8:172-182 173dans l'attente d'une validation par une étude randomisée. Dans cette situation curative, le traitement chirurgical de l'occlusion est à privilégier.• • En situation palliative (métastases non résécables, patient non opérable), la prothèse colique peut être recommandée en première intention. Dans cette situation, la chirurgie est une autre option thérapeutique.• • Chez les patients porteurs d'une prothèse colique, l'utilisation d'un traitement antiangiogénique peut entraîner des complications locales plus fréquentes (contre-indication relative), de même la pose d'une prothèse chez un patient traité par un traitement antiangiogénique est déconseillée.• • Les données d'efficacité à court terme des prothèses coliques sont globalement bonnes, par contre, il existe peu de données sur les résultats à long terme et chez les patients recevant secondairement un traitement de chimiothérapie associé ou non à une thérapie ciblée.

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“…A few randomized controlled trials and a cohort study have shown a significantly higher local disease recurrence rate with SEMS use than emergent surgery [7][8][9][10] . According to the European Society of Gastrointestinal Endoscopy (ESGE) guidelines, SEMS placement as a BTS is not recommended as a standard treatment for potentially curable patients with obstructive colorectal cancer [11] .…”

Section: Introductionmentioning

confidence: 99%

The Feasibility of 18-mm-Diameter Colonic Stents for Obstructive Colorectal Cancers

Ogawa

Ishii²,

Minaga³

et al. 2017

Oncology

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Objectives: This study aimed to evaluate the characteristics and the feasibility of 18-mm-diameter stents for obstructive colorectal cancer, comparing the clinical courses with 22- mm-diameter stents. Methods: We retrospectively compared 33 consecutive cases treated with 18-mm-diameter stents (bridge to surgery [BTS] in 25, palliative therapy [PAL] in 8) with 27 consecutive cases treated with 22-mm-diameter stents (BTS in 21, PAL in 6) for obstructive colorectal cancer between May 2013 and November 2015 in our institution. Results: There were no significant differences between the 18-mm and 22-mm groups in technical success rates (97 and 96%, respectively) and clinical success rates (100 and 100%, respectively). As a BTS, the rates of complications and stoma formation were not significantly different between groups. For PAL, although the rates of complications and stent patency were similar, stent occlusion occurred in 1 patient (12.5%) in the 18-mm group. Conclusions: The 18-mm-diameter stents were similarly effective when compared with 22-mm-diameter stents. Because 18-mm-diameter stents are easy to handle and produce less mechanical stress, they have the potential to decrease the perforation rate and mitigate the stent's impact on the tumors. 18-mm-diameter stents can be useful and safe, especially as a BTS.

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Prospective, Controlled, Randomized Study of Intraoperative Colonic Lavage Versus Stent Placement in Obstructive Left‐sided Colonic Cancer

Abstract: In our setting, the use of a stent and scheduled surgery is safer than IOCL and is associated with lower morbidity, shorter hospital stay, and equally good long-term survival.

Cited by 203 publications

References 55 publications

Colonic cancer: The current role of stent insertion

Colonic cancer: The current role of stent insertion

Place des prothèses coliques dans la stratégie thérapeutique du cancer colorectal

The Feasibility of 18-mm-Diameter Colonic Stents for Obstructive Colorectal Cancers

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