Short-term outcomes of a self-expandable metallic stent as a bridge to surgery vs. a transanal decompression tube for malignant large-bowel obstruction: a meta-analysis

Matsuda, Akihisa; Yamada, Takeshi; Matsumoto, Satoshi; Sakurazawa, Nobuyuki; Kawano, Youichi; Sekiguchi, Kumiko; Matsutani, Takeshi; Miyashita, Masao; Yoshida, Hiroshi

doi:10.1007/s00595-019-01784-y

Cited by 31 publications

(30 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…TADT was one of decompression methods of BTS for OLCRC since the 1990s because SEMS was not being covered by insurance system in Japan. But there has been no consensus on the evaluation of TADT, and it is still controversial [6,31]. Although TADT is considered to have a negative impact on QOL, the expenses of TADT is much lower than that of SEMS.…”

Section: Discussionmentioning

confidence: 99%

“…For these reasons, TADT has been used as a procedure of BTS in some Asian countries [32,33]. In a meta-analysis comparing the success rates, both technical and clinical success rates were significantly better for SEMS than for TADT [6]. This meta-analysis also reported significantly better tumor resection rates, primary anastomosis rates, stoma rates for SEMS, and trend to benefit in the SEMS than in the TADT for complications related to decompression including perforation (though the difference was not significant).…”

Section: Discussionmentioning

confidence: 99%

“…Since there is solid stool matter in the dilated colon of patients with colonic obstruction due to left-sided CRC, TADT is not so effective, and management during decompression is complicated. Inevitably, placement of a tube from the anus also has a significant negative impact on the patient's quality of life (QOL) [6].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Comparison of survival and perioperative outcome of the colonic stent and the transanal decompression tube placement and emergency surgery for left-sided obstructive colorectal cancer: a retrospective multi-center observational study “The CODOMO study”

Endo

Kumamoto

Enomoto

et al. 2020

Int J Colorectal Dis

View full text Add to dashboard Cite

Purpose Advances in endoscopic technology have led to the reevaluation of self-expandable metallic stent (SEMS) placement as a bridge-to-surgery (BTS) in patients with obstructive colorectal cancer. In Japan, after inclusion of SEMS placement as a BTS in the medical insurance coverage in 2012, this procedure has been increasingly performed. However, a transanal decompression tube (TADT) placement has been used as a BTS. We aimed to retrospectively evaluate the optimal strategy for obstructive left-sided colorectal cancer (OLCRC) by comparing SEMS and TADT placement with emergency surgery. Methods We included 301 patients with stage II and III OLCRC from 27 institutions. The study patients were divided into Surgery group (emergency surgery, n = 103), SEMS group (BTS by SEMS, n = 113), and TADT group (BTS by TADT, n = 85). We compared the survival and perioperative outcomes of patients in the Surgery group as a standard treatment with those in the SEMS and TADT groups. Results The 3-year relapse-free survival rate in patients in the Surgery group was 74.8%, while that in patients in the SEMS group and TADT group were 69.0% (p = 0.39) and 55.3% (p = 0.006), respectively. The technical success rate was not statistically different, but the clinical success rate was significantly higher in the SEMS group than in the TADT group (p = 0.0040). With regard to postoperative complications after curative surgery, the SEMS group had significantly lower of complications (≥ grade 2) than the Surgery group (p = 0.022). Conclusion Patients who underwent SEMS placement for OLCRC had similar oncological outcomes to patients who underwent emergency surgery.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of survival and perioperative outcome of the colonic stent and the transanal decompression tube placement and emergency surgery for left-sided obstructive colorectal cancer: a retrospective multi-center observational study “The CODOMO study”

Endo

Kumamoto

Enomoto

et al. 2020

Int J Colorectal Dis

View full text Add to dashboard Cite

show abstract

“…As an alternative to colonic decompression, insertion of a transanal decompression tube (TDT) is only rarely done, with most case series being performed in south-east Asian countries. A recent meta-analysis on TDT versus colonic stenting as a bridge to surgery reported lower technical success, lower clinical success, fewer primary tumor resections, fewer primary anastomoses, and more stomas for TDT than colonic stenting [114]. Therefore, ESGE does not recommend TDT placement over colonic stent placement.…”

Section: Recommendationmentioning

confidence: 99%

Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2020

et al. 2020

View full text Add to dashboard Cite

Main RecommendationsThe following recommendations should only be applied after a thorough diagnostic evaluation including a contrast-enhanced computed tomography (CT) scan. 1 ESGE recommends colonic stenting to be reserved for patients with clinical symptoms and radiological signs of malignant large-bowel obstruction, without signs of perforation. ESGE does not recommend prophylactic stent placement.Strong recommendation, low quality evidence. 2 ESGE recommends stenting as a bridge to surgery to be discussed, within a shared decision-making process, as a treatment option in patients with potentially curable left-sided obstructing colon cancer as an alternative to emergency resection.Strong recommendation, high quality evidence. 3 ESGE recommends colonic stenting as the preferred treatment for palliation of malignant colonic obstruction.Strong recommendation, high quality evidence. 4 ESGE suggests consideration of colonic stenting for malignant obstruction of the proximal colon either as a bridge to surgery or in a palliative setting.Weak recommendation, low quality evidence. 5 ESGE suggests a time interval of approximately 2 weeks until resection when colonic stenting is performed as a bridge to elective surgery in patients with curable left-sided colon cancer.Weak recommendation, low quality evidence. 6 ESGE recommends that colonic stenting should be performed or directly supervised by an operator who can demonstrate competence in both colonoscopy and fluoroscopic techniques and who performs colonic stenting on a regular basis.Strong recommendation, low quality evidence. 7 ESGE suggests that a decompressing stoma as a bridge to elective surgery is a valid option if the patient is not a candidate for colonic stenting or when stenting expertise is not available.Weak recommendation, low quality evidence.

show abstract

“…If a thorough evaluation after stent placement indicates the presence of an irresectable tumour, a surgical procedure would therefore be avoided. A number of prospective controlled studies and meta-analyses have shown that SEMS has a good short-term effect as a bridge to surgery (BTS) compared with emergency surgery [12][13][14]. Although the short-term benefits of SEMS as a BTS have been established in recent years, the promotion of metastasis caused by stent implantation remains suspected due to blood dissemination produced by tumour compression [15].…”

Section: Introductionmentioning

confidence: 99%

Long-term tumour outcomes of self-expanding metal stents as ‘bridge to surgery’ for the treatment of colorectal cancer with malignant obstruction: a systematic review and meta-analysis

Cao

Deng

et al. 2019

Int J Colorectal Dis

View full text Add to dashboard Cite

Purpose To explore the long-term oncological results of self-expanding metal stents (SEMS) as a surgical transition compared with those of simple emergency surgery. Methods A systematic review of studies involving long-term tumour outcomes comparing SEMS with emergency surgery was conducted. All studies included information on 3-year and 5-year survival rates, 3-year and 5-year disease-free survival (DFS) rates, and local and overall recurrence rates; the results were expressed as odds ratios. Results Overall, 24 articles and 2508 patients were included, including 5 randomised controlled trials, 3 prospective studies, and 16 retrospective studies. The 3-year survival rate (odds ratio (OR) = 0.88, 95% confidence interval (CI) 0.69-1.12, P = 0.05), 5-year survival rate (OR = 0.91, 95% CI 0.70-1.17, P = 0.67), 3-year DFS rate (OR = 1.14, 95% CI 0.91-1.42, P = 0.65), 5-year DFS rate (OR = 1.35, 95% CI 0.91-2.02, P = 0.17), overall recurrence rate (OR 1.04, 95% CI 0.77-1.41, P = 0.14), and local recurrence rate (OR 1.37, 95% CI 0.84-2.23, P = 0.92) were determined. There was no significant difference between the randomised and observational studies in the subgroup analysis, and the 5-year survival rate was higher in studies with a stent placement success rate of ≥ 95%. Conclusion SEMS implantation was a viable alternative in malignant left colon obstruction as a transition to surgery; its longterm survival results, including 5-year DFS and overall survival, were equivalent to those of emergent surgery.

show abstract

Short-term outcomes of a self-expandable metallic stent as a bridge to surgery vs. a transanal decompression tube for malignant large-bowel obstruction: a meta-analysis

Cited by 31 publications

References 33 publications

Comparison of survival and perioperative outcome of the colonic stent and the transanal decompression tube placement and emergency surgery for left-sided obstructive colorectal cancer: a retrospective multi-center observational study “The CODOMO study”

Comparison of survival and perioperative outcome of the colonic stent and the transanal decompression tube placement and emergency surgery for left-sided obstructive colorectal cancer: a retrospective multi-center observational study “The CODOMO study”

Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2020

Long-term tumour outcomes of self-expanding metal stents as ‘bridge to surgery’ for the treatment of colorectal cancer with malignant obstruction: a systematic review and meta-analysis

Contact Info

Product

Resources

About