Upfront surgery versus self-expanding metallic stent as bridge to surgery in left-sided colonic cancer obstruction: A multicenter observational study

Hidalgo-Pujol, Marta; Biondo, Sebastiano; Trill, Javier Díe; Vigorita, Vincenzo; García-Señoráns, Marta Paniagua; Migueláñez, Isabel Pascual; Noire, Fernando Prieto-La; Timoteo, Ander; Cornejo, Lídia; Parra, José Ignacio Martín; García, María Fidalgo; Solís-Peña, Alejandro; Tudela, Arturo Cirera de; González, Araceli Rodriguez; Sánchez‐Guillén, Luis; Recuenco, Carlos Bustamante; Pérez-Alonso, Carla; Caballero, Elena Hurtado; Pascual, Marta; Septiem, Javier García; Mora, Laura; Cervera-Aldama, J.; Guadalajara, Héctor; Espín, Eloy; Kreisler, Esther; Frago, Ricardo; Fraccalvieri, Doménico; Trenti, Loris; Gálvez, Ana; Iñíguez, Iñigo Arana; Sebastián, Antonio Arroyo; Rubio, Ainhoa Valle; Frasson, Matteo; Gómez, Luís Héctor Hernández; Pérez, Araceli Ballestero; García-González, J. M.; Buendía, Jabier Barambio

doi:10.1016/j.surg.2021.12.035

Cited by 7 publications

(4 citation statements)

References 47 publications

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“…There have been mixed reports in regard to disease recurrence in the SEMS group compared to upfront surgery. Some studies reported higher recurrence rates in the SEMS group [ 10 , 16 , 17 ]; others reported no differences in local and distant recurrence rates [ 15 , 21 ]. Our data showed that local recurrence was seen in only 2 patients (11.8%) in the SEMS group, and distant metastasis was seen in 5 (29.4%) vs. 7 (25%) in SEMS and upfront surgery groups, respectively.…”

Section: Discussionmentioning

confidence: 99%

5-year oncological outcomes in left-sided malignant colonic obstruction: stent as bridge to surgery

Alhassan,

AlShammari,

AlRabah

et al. 2023

BMC Gastroenterol

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Background A considerable number of patients with colon cancer present with a colonic obstruction. The use of self-expanding metallic stents (SEMS) as a bridge to surgery (BTS) in potential curative patients with left-sided colonic cancer obstruction remains debatable. Therefore, this study aimed to investigate the 5-year oncological outcomes of using a SEMS as a BTS. Methods All patients with left-sided malignant colon obstruction who underwent curative surgery with no metastasis upon presentation between March 2009 and May 2013 were retrospectively reviewed and analyzed. Results A total of 45 patients were included, 28 patients underwent upfront surgery, and 17 patients had a stent as a bridge to surgery. T4 stage was statistically significantly higher in patients who had a SEMS as a BTS (35.3% vs. 10.7%) (p-value 0.043). The mean duration in days of the SEMS to surgery was 13.76 (SD 10.08). TNM stage 3 was a prognostic factor toward distant metastasis (HR 5.05). When comparing patients who had upfront surgery to those who had a SEMS as a BTS, higher 5-year disease-free survival (75% vs. 72%) and 5-year overall survival (89% vs. 82%) were seen in patients who had upfront surgery. However, both were statistically insignificant. Conclusion Using self-expanding metallic stents as a bridge to surgery yields comparable 5-year survival and disease-free survival rates to upfront emergency surgery. The decision to use SEMS versus opting for emergency surgery should be made after careful patient selection and with the assistance of experienced endoscopists. Trial registration N/A.

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Section: Discussionmentioning

confidence: 99%

5-year oncological outcomes in left-sided malignant colonic obstruction: stent as bridge to surgery

Alhassan,

AlShammari,

AlRabah

et al. 2023

BMC Gastroenterol

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“…SEMS placement achieves the purpose of temporary decompression, which would not only help to eliminate the adverse effects of edema after intestinal obstruction on radical surgical operations, but also would reduce the difficulty of elective surgery. SEMS placement also buys time for bowel preparation to improve bowel blood supply, adjust the nutritional status of patients, reduce surgical risks, reduce postoperative complications such as anastomotic leakage, and speed up postoperative recovery (7,8,29). In addition, SEMS implantation is a palliative treatment, which helps to reduce postoperative pain compared with enterostomy, to shorten the postoperative hospital stay and to promote the early recovery of patients.…”

Section: Discussionmentioning

confidence: 99%

Short-term effect of different time interval between self-expanding metallic stent and surgery for left-sided malignant colorectal obstruction

Zhang¹,

Su²,

Lin³

et al. 2022

Front. Gastroenterol.

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BackgroundThe optimal time interval between self-expanding metallic stent (SEMS) placement and surgery in patients with left-sided malignant colorectal obstruction (LMCO) remains controversial. Intestinal obstruction and SEMS placement would lead to intestinal edema, local tumor infiltration, and fibrosis, which may have a certain impact on elective surgery. Although prolong time interval would reduce relative complications, the risk of tumor progression must be taken into account. Therefore, our study proposes whether there is a difference in short-term postoperative complication outcomes between waiting for an interval of ≤4weeks compared with an extended interval for neoadjuvant chemotherapy followed by surgery.MethodsAll patients who underwent SEMS placement as BTS treatment for LMCO between January 2012 and December 2021 were retrospectively identified. The primary outcomes of this study were short-term clinical postoperative complications (Clavien-Dindo grading ≥II).ResultsOf the 148 patients, 70.27% of patients underwent surgery ≤4 weeks of SEMS placement (Group 1) while 29.73% of patients underwent surgery >4 weeks of SEMS placement (Group 2). After SEMS placement, the patients in Group 2 received neoadjuvant chemotherapy and then elective surgery. Significant differences were observed between both groups (Group 2 vs Group 1) for postoperative complications (Clavien-Dindo grading ≥II, 2.3% vs 14.4%, p=0.040), postoperative bowel function time (p<0.001), postoperative hospital stay (p=0.028) and total hospital stay (p=0.002).ConclusionsA bridging interval of >4 weeks between SEMS placement and surgery for LMCO has better short-term clinical outcome.

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“…In February 2022, a multicentric study[ 62 ] including 564 patients was published. The results showed the “non-inferiority” of BTS vs ES in terms of OS ( P = 0.012).…”

Section: Long-term Outcomesmentioning

confidence: 99%

Colonic stent for bridge to surgery for acute left-sided malignant colonic obstruction: A review of the literature after 2020

2022

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It has been found that 8%-29% of colorectal cancers are obstructive. The use of “stent as bridge to surgery” is one of the most debated topics in obstructive left-sided colorectal cancer management. The endoscopic placement of a self-expanding metallic stent as bridge to surgery (BTS) could turn an emergency surgery to an elective one, increasing the number of primary anastomoses instead of stoma and facilitating the laparoscopic approach instead of an open one. However, in recent years the possible risk of perforations and microperforations facilitating cancer spread related to the use of self-expanding metallic stent for BTS has been highlighted. Therefore, despite the useful short-term outcomes related to BTS, the recent literature has focused on long-term outcomes investigating the disease-free survival, the recurrence rate and the overall survival. Due to discordant data, international guidelines are still conflicting, and the debate is still open. There is not agreement about using self-expanding metallic stent for BTS as the gold standard.

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Upfront surgery versus self-expanding metallic stent as bridge to surgery in left-sided colonic cancer obstruction: A multicenter observational study

Cited by 7 publications

References 47 publications

5-year oncological outcomes in left-sided malignant colonic obstruction: stent as bridge to surgery

5-year oncological outcomes in left-sided malignant colonic obstruction: stent as bridge to surgery

Short-term effect of different time interval between self-expanding metallic stent and surgery for left-sided malignant colorectal obstruction

Colonic stent for bridge to surgery for acute left-sided malignant colonic obstruction: A review of the literature after 2020

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