A prospective multicenter study on self-expandable metallic stents as a bridge to surgery for malignant colorectal obstruction in Japan: efficacy and safety in 312 patients

Saito, Shuji; Yoshida, Shuntaro; Isayama, Hiroyuki; Matsuzawa, T.; Kuwai, Toshio; Maetani, Iruru; Shimada, M.; Yamada, Terumasa; Tomita, Mitsuhiro; Koizumi, Koichi; Hirata, Nobuto; Kanazawa, Hideki; Enomoto, Toshiyuki; Sekido, Hitoshi; Saida, Yoshihisa

doi:10.1007/s00464-015-4709-5

Cited by 108 publications

(122 citation statements)

References 43 publications

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“…JCSSPRG conducted two multicenter prospective feasibility studies to investigate the safety and effectiveness of colonic stenting. The first study was conducted using only the WallFlex™ enteral colonic stent (Boston Scientific Corporation, Marlborough, MA) [12, 13], and the second subsequent study was conducted using only the Niti-S™ type D enteral colonic stent (TaeWoong, Inc., Seoul, South Korea) in the same setting.…”

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confidence: 99%

Self-expandable metallic stenting as a bridge to surgery for malignant colorectal obstruction: pooled analysis of 426 patients from two prospective multicenter series

Tomita

Saito²,

Makimoto

et al. 2018

Surg Endosc

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confidence: 99%

Self-expandable metallic stenting as a bridge to surgery for malignant colorectal obstruction: pooled analysis of 426 patients from two prospective multicenter series

Tomita

Saito²,

Makimoto

et al. 2018

Surg Endosc

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“…Accordingly, OCRC patients with stenting as a BTS should be able to undergo preoperative colonoscopy to evaluate mucosal changes, including obstructive colitis and mucosal edema. Furthermore, recent noteworthy papers reported that stent insertion is now safe due to better techniques, improved training and experience of the physicians who perform this procedure, and clearer guidelines (17,19,20).…”

Section: Discussionmentioning

confidence: 99%

Impact of endoscopic stent insertion on detection of viable circulating tumor cells from obstructive colorectal cancer

et al. 2017

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Abstract. The placement of a self-expanding metallic stent (SEMS) in obstructive colorectal cancer (OCRC) is acknowledged to be a safe and effective procedure for the relief of obstruction. However, there is concern that shear forces acting on the tumor during stent expansion may release cancer cells into the circulation, resulting in a poor prognosis. The aim of the present study was to determine whether colonic stent insertion increases viable circulating tumor cells (v-CTCs). A telomerase-specific replication-selective adenovirus-expressing GFP (TelomeScanF35) detection system was used to detect v-CTCs in 8 OCRC patients with a SEMS before and after stent insertion and after surgical resection. In 7 patients, a SEMS was inserted as a bridge to surgery (BTS), and in one patient, a SEMS was inserted for palliation. Surgical resection (R0) was performed in 7 patients. Four patients had no v-CTCs before SEMS placement, two of four measurable patients had an increased number of v-CTCs after SEMS placement (1-3 v-CTCs), and one of two patients with increased v-CTCs developed distant lymphatic metastasis despite curative resection. Four patients had v-CTCs (1-19 cells) before SEMS placement, and two of these four patients had an increase in the number of v-CTCs (20-21 cells) after SEMS placement, while one of the four patients died early with distant metastasis. The present study demonstrated that endoscopic stent insertion for OCRC may result in tumor cell dissemination into the peripheral circulation and may induce distant metastases. IntroductionAt the time of the initial diagnosis of colorectal cancer, 8-13% of patients have obstructive symptoms (1,2). The treatment of choice for these patients has traditionally been emergency surgery. However, most studies have found that the morbidity and mortality rates are higher for emergency colorectal surgery than for elective surgery, and a temporary colostomy, which decreases patients' quality of life, is needed in many patients, which, in 10-40% of cases, becomes permanent (3). The purpose of stenting as a bridge to surgery (BTS) is to relieve the acute situation without emergency surgery, allowing elective surgery to be performed and thus improve surgical outcomes, determine the correct tumor stage, detect synchronous lesions, stabilize comorbidities, and carry out laparoscopic surgery. Immediate results in higher surgical risk patients who were stented were better for primary anastomosis, permanent stoma, wound infection, and overall morbidity, resulting in greater benefit. However, stent insertion was recently reported to have a high risk of perforation, re-obstruction, or stent migration (4,5). Moreover, perforations can lead to peritoneal dissemination. Sabbagh et al (6) reported worse overall survival and higher 5-year cancer-specific mortality of left-sided obstructive colorectal cancer (OCRC) patients with self-expanding metallic stent (SEMS) insertion than emergency surgery due to perforation induced by stent insertion. Furthermore, SEMS insertion as a BTS is ...

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“…The anastomotic leakage rate is higher when the interval is 1-9 days than 10 days or longer [22] , although longer intervals may increase the stentrelated complication rate. A certain period may allow for better recovery and optimal nutrition [15] , and this optimal interval should be established in future studies. Though the interval of the 18-mm group was significantly longer, it is because the waiting time of the surgery has become longer in our hospital nowadays.…”

Section: Btsmentioning

confidence: 99%

“…To evaluate the level of oral intake, we used the ColoRectal Obstruction Scoring System (CROSS), which assigns a point score based on the patient's oral intake level: CROSS 0, requiring continuous decompression; CROSS 1, no oral intake; CROSS 2, liquid or enteral nutrient intake; CROSS 3, soft solids, low residue, and full diet with symptoms of stricture; and CROSS 4, soft solids, low residue, and full diet without symptoms of stricture [15,16] .…”

Section: Definitionsmentioning

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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A prospective multicenter study on self-expandable metallic stents as a bridge to surgery for malignant colorectal obstruction in Japan: efficacy and safety in 312 patients

Abstract: This largest, multicenter, prospective study demonstrates the feasibility of SEMS placement as a BTS for malignant colorectal obstruction. SEMS serves as a safe and effective BTS with acceptable stoma creation and complication rates in patients with acute malignant colonic obstruction.

Cited by 108 publications

References 43 publications

Self-expandable metallic stenting as a bridge to surgery for malignant colorectal obstruction: pooled analysis of 426 patients from two prospective multicenter series

Self-expandable metallic stenting as a bridge to surgery for malignant colorectal obstruction: pooled analysis of 426 patients from two prospective multicenter series

Impact of endoscopic stent insertion on detection of viable circulating tumor cells from obstructive colorectal cancer

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

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