Bridge to surgery using a self-expandable metallic stent for stages II–III obstructive colorectal cancer

Ohta, Katsuya; Ikenaga, Masakazu; Ueda, Masami; Iede, Kiyotsugu; Tsuda, Yujiro; Nakashima, Shinsuke; Nojiri, Takashi; Matsuyama, Jin; Endo, Shunji; Murata, Jun; Kobayashi, Ichizo; Tsujii, Masahiko; Yamada, Terumasa

doi:10.1186/s12893-020-00847-z

Cited by 4 publications

(4 citation statements)

References 46 publications

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“…As SEMS mechanically dilates the lumen in OCRC, there are concerns regarding the dissemination of tumors into the peritoneal cavity [28], invasion of tumor cells into the venous [29] and lymphatic vessels [30], and perineural invasion [31]. However, according to histopathological examinations conducted in previous studies, these factors were not exacerbated by SEMS placement [13,24]; this is consistent with the results of the present study.…”

Section: Discussionsupporting

confidence: 91%

Comparison of Oncological and Perioperative Outcomes Between Self‐Expanding Metal Stents and Decompression Tubes for Stages II and III Obstructive Colorectal Cancer: A Retrospective Observational Study

et al. 2023

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Background A bridge to surgery (BTS) using self‐expandable metallic stents (SEMSs) is becoming the primary treatment for obstructive colorectal cancer (OCRC). In Japan, intestinal decompression was usually performed using decompression tubes (DTs). However, few reports have compared the outcomes of SEMS and DTs as BTS. Therefore, we compared the treatment outcomes of SEMS and DTs for OCRC. Methods Data of 80 patients who underwent radical resection after endoscopic decompression for stage II or III OCRC between 2007 and 2021 were retrospectively analyzed. Patients were divided into two groups based on whether they received SEMS (n = 53) or DTs (n = 27). Results The clinical success rate of decompression was 96.2% and 88.9% in the SEMS and DT groups, respectively. Additionally, 96.2% of patients who received SEMS were able to resume their routine diet without stricture symptoms. The rate of stoma construction and incidence of postoperative complications were lower in the SEMS group (p < 0.005 and p < 0.01, respectively). The 3‐year relapse‐free survival rates were 71.9% and 51.2% in the SEMS and DT groups, respectively, which were not significantly different (p = 0.10). Conclusion BTS using SEMS might be an adequate treatment for stage II or III OCRC regardless of tumor location owing to the comparable oncological outcomes with DT and low perioperative complication rate.

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Section: Discussionsupporting

confidence: 91%

Comparison of Oncological and Perioperative Outcomes Between Self‐Expanding Metal Stents and Decompression Tubes for Stages II and III Obstructive Colorectal Cancer: A Retrospective Observational Study

et al. 2023

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“…Sabbagh et al reported that in left-sided obstructive colorectal cancer, post-stent insertion surgery had a poorer long-term prognosis, with more tumor and peritumoral ulceration, perineural invasion, and lymph node metastasis 10,12) . Ohta et al reported that surgical cases after stent insertion had higher rates of lymph node metastasis and venous invasion and poorer 3-year OS than emergency resection 11) . Meta-analyses of RCTs by Foo et al and Yang et al reported no difference regarding survival, but a higher recurrence rate was observed in left-sided obstructive colorectal cancer 7,8) .…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, there is no consensus on the long-term prognosis. There are reports of stent insertion adversely affecting pathological findings such as lymph node metastases, vascular invasion, and nerve invasion 10,11) , as well as poor long-term prognosis 11,12) . A 46-center prospective study in Japan reported a high success rate of stent insertion with favorable long-term prognosis 13) .…”

Section: Introductionmentioning

confidence: 99%

Effects of Colonic Stent as a Bridge to Surgery on Postoperative Short- and Long-term Outcomes: Comparison of Stent and Non-Stent Management in our Hospital

Fukuoka

Makizumi

Asano

et al. 2023

J St. Marianna Univ

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Objectives: Colonic stent insertion as a bridge to surgery (BTS) has the advantage of avoiding emergency colostomy and is reported to have a lower postoperative complication rate than emergency resection or resection after stoma construction. Nevertheless, there is no consensus on the long-term prognosis; moreover, there are reports of stent insertion adversely affecting pathological findings. To clarify the influence of colorectal stent insertion on short-term postoperative results, pathological findings, and prognosis, we conducted this study. Methods: Patients who had undergone resection of the primary tumor for primary colorectal cancer at our hospital between January 2012 and December 2020 and had preoperative colorectal obstruction (Colorectal Obstruction Scoring System [CROSS]) 0-2 were included. Patient were divided into two groups: those with and without preoperative colonic stent insertion. The background, surgical course, histopathological findings, shortterm postoperative outcomes, and the prognosis of both groups were retrospectively examined. Results: There were 197 cases, 55 with preoperative colorectal stent insertion (stent group) and 142 without stent insertion (non-stent group). The rate of open surgery was significantly higher and postoperative hospital stay was longer in the non-stent group. There were no significant differences regarding histopathology findings, 3-year overall survival, and recurrences. Conclusions: The short-term postoperative results of patients with stent insertion were favorable, and it seems reasonable to continue stent insertion for the purpose of BTS; however, further study is required regarding prognosis.

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“…In a comparative study between emergency surgery and BTS using SEMS, age, performance status, depth of invasion, and lymph node metastasis were prognostic factors for disease-free survival [ 27 ]. A Japanese study of 50 cases of emergency surgery and 50 cases of BTS using SEMS for Stage II/III obstructive CRC showed that BTS and positive venous invasion were poor prognostic factors for RFS, and BTS and T4 cancer were poor prognostic factors for overall survival (OS) [ 28 ]. Long-term outcomes (OS and disease-free survival [DFS]) of emergency surgery and BTS using SEMS were equivalent, but NLR was a prognostic factor for DFS in emergency surgery.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors of patients with left-sided obstructive colorectal cancer: post hoc analysis of a retrospective multicenter study by the Japan Colonic Stent Safe Procedure Research Group

et al. 2022

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Background There are many reports on the choice of treatment for and prognosis of left-sided obstructive colorectal cancer; however, few studies have focused on the prognostic factors of left-sided obstructive colorectal cancer. Therefore, we analyzed the prognostic factors using a post hoc analysis of a retrospective multicenter study in Japan. Methods A total of 301 patients were enrolled in this study to investigate the prognostic factors for relapse-free survival. The relationships between sex, age, decompression for bridge to surgery, depth of invasion, lymph node metastasis, postoperative complications, adjuvant chemotherapy, carcinoembryonic antigen, carbohydrate antigen 19-9, neutrophil-to-lymphocyte ratio, and relapse-free survival were examined. Results No change in the decompression method, T3 cancer, negative postoperative complications (grades 0–1 of Clavien-Dindo classification), and adjuvant chemotherapy during Stage III indicated a significantly better prognosis in a Cox univariate analysis. Lymph node metastasis was not selected as a prognostic factor. Excluding patients with <12 harvested lymph nodes (possible stage migration), lymph node metastasis was determined as a prognostic factor. In a Cox multivariate analysis, change in the decompression method, depth of invasion, lymph node metastasis (excluding N0 cases with <12 harvested lymph nodes), and adjuvant chemotherapy were prognostic factors. Conclusions Similar to those in nonobstructive colorectal cancer, depth of invasion and lymph node metastasis were prognostic factors in left-sided obstructive colorectal cancer, and patients with <12 dissected lymph nodes experienced stage migration. Stage migration may result in disadvantages, such as not being able to receive adjuvant chemotherapy.

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Bridge to surgery using a self-expandable metallic stent for stages II–III obstructive colorectal cancer

Cited by 4 publications

References 46 publications

Comparison of Oncological and Perioperative Outcomes Between Self‐Expanding Metal Stents and Decompression Tubes for Stages II and III Obstructive Colorectal Cancer: A Retrospective Observational Study

Comparison of Oncological and Perioperative Outcomes Between Self‐Expanding Metal Stents and Decompression Tubes for Stages II and III Obstructive Colorectal Cancer: A Retrospective Observational Study

Effects of Colonic Stent as a Bridge to Surgery on Postoperative Short- and Long-term Outcomes: Comparison of Stent and Non-Stent Management in our Hospital

Prognostic factors of patients with left-sided obstructive colorectal cancer: post hoc analysis of a retrospective multicenter study by the Japan Colonic Stent Safe Procedure Research Group

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