Colonic stent as a bridge to surgery versus emergency resection for right-sided malignant large bowel obstruction: a meta-analysis

Kanaka, Shintaro; Matsuda, Akihisa; Yamada, Takeshi; Ohta, Ryo; Sonoda, Hiromichi; Shinji, Seiichi; Takahashi, Goro; Iwai, Takuma; Takeda, Kohki; Ueda, Koji; Kuriyama, Satoru; Miyasaka, Toshimitsu; Yoshida, Hiroshi

doi:10.1007/s00464-022-09071-7

Cited by 14 publications

(16 citation statements)

References 42 publications

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“…In addition, the mortality and morbidity rates in the right-sided group seem to be better than those in previous studies on emergency surgery [29,30]. A meta-analysis of Kanaka et al reported that BTS using SEMS for right-sided OCRC reduces the postoperative mortality and morbidity rates compared with emergency surgery [32]. Our results and these studies suggest that even though the concerns of postoperative ileus or SBO remain, SEMS placement for right-sided OCRC can be an option.…”

Section: Discussioncontrasting

confidence: 39%

Comparison of Short-term Outcomes of a Self-expandable Metallic Stent as a Bridge to Laparoscopic Surgery between Right- and Left-sided Obstructive Colorectal Cancers: A Retrospective Observational Study

Sato

Imaizumi

Kasajima

et al. 2022

J Anus Rectum Colon

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Objectives: Few studies have compared the tumor-site-based postoperative short-term outcomes of a bridge to surgery using self-expandable metallic stents. This study compared the perioperative outcomes following stent placement between right-and left-sided obstructive colorectal cancers, focusing on patients undergoing laparoscopic surgery. Methods: This study included 127 patients with stage I-IV obstructive colorectal cancer (right-sided, n = 25 [19.7%]; left-sided, n = 102 [80.3%]) who underwent laparoscopic-assisted surgery following stent placement between May 2012 and September 2021. We compared the postoperative complication rates and the success rates of stent placement. Results:The clinical success rate was not significantly different (92% vs. 97.1%, P = 0.254). The rates of all-grade complications (36% vs. 16.7%, P = 0.05) and postoperative ileus or small-bowel obstruction (20% vs. 2%, P = 0.003) were significantly higher in the right-sided group. The rates of the Clavien-Dindo classification !III complications (8% vs. 6.9%, P = 1) and the median durations of postoperative hospital stay (8 days vs. 8 days, P = 1) were not significantly different. On multivariate analysis, right-sided colon cancer was an independent risk factor for postoperative ileus or small-bowel obstruction (odds ratio [OR]: 16.5, 95% confidence interval [CI]: 2.42-112, P = 0.004) but not for all grades of complications (OR: 2.63, 95% CI: 0.976-7.09, P = 0.056). Conclusions: Although the rates of clinical success, postoperative Clavien-Dindo classification !III severe complications, and postoperative hospital stay were comparable, the bridge to surgery following stent placement for right-sided obstructive colon cancer raises concerns about ileus or small-bowel obstruction.

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Section: Discussioncontrasting

confidence: 39%

Comparison of Short-term Outcomes of a Self-expandable Metallic Stent as a Bridge to Laparoscopic Surgery between Right- and Left-sided Obstructive Colorectal Cancers: A Retrospective Observational Study

Sato

Imaizumi

Kasajima

et al. 2022

J Anus Rectum Colon

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“…However, recent studies have demonstrated significantly higher operative risks for emergency resection compared with decompression, even though emergency surgery is the standard therapy in right‐sided MLBO 23,24 . Studies reporting the short‐term safety of BTS using SEMS have emerged for right‐sided MLBO, and we recently published a meta‐analysis demonstrating that SEMS as BTS contributed to a significant reduction in postoperative complications and mortality compared with emergency surgery (OR = 0.78, 95% CI = 0.66–0.92 and OR = 0.51, 95% CI = 0.28–0.92, respectively) 25 . Additionally, the recent ESGE guidelines suggest consideration of SEMS placement for right‐sided MLBO.…”

Section: Discussionmentioning

confidence: 99%

Long‐term outcomes between self‐expandable metallic stent and transanal decompression tube for malignant large bowel obstruction: A multicenter retrospective study and meta‐analysis

Matsuda

Yamada

Yokoyama

et al. 2023

Annals of Gastroent Surgery

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Aim To compare the oncological outcomes between self‐expandable metallic stent (SEMS) as a bridge to surgery and transanal decompression tube (TDT) placement for malignant large bowel obstruction (MLBO). Methods A total of 287 MLBO patients who underwent SEMS (n = 137) or TDT placement (n = 150) were enrolled in this multicenter retrospective study. Overall survival (OS) and disease‐free survival (DFS) between the two groups were compared. A meta‐analysis was performed using random‐effects models to calculate odd ratios (OR) with 95% confidence intervals (CIs). Results Postoperative complications of Clavien–Dindo grade ≥II and ≥III occurred frequently in the TDT group compared with the SEMS group (P = 0.002 and 0.005, respectively). The 3‐y OS in the overall cohort and 3‐y DFS in the pathological stage II/III cohort in the SEMS and TDT groups were 68.6% and 71.4%, and 71.0% and 72.6%, respectively. The survival differences were not significantly different in the OS and DFS analyses (P = 0.819 and P = 0.892, respectively). A meta‐analysis of nine studies (including our cohort data) demonstrated no significant difference between the SEMS and TDT groups for 3‐y OS and DFS (OR = 0.96, 95% CI = 0.57–1.62, P = 0.89 and OR = 0.69, 95% CI = 0.46–1.04, P = 0.07, respectively). Conclusion Our study demonstrated that SEMS placement had no inferiority regarding long‐term outcomes, including OS and DFS, compared with TDT placement. Considering the short‐term benefits of SEMS placement, this could be a preferable preoperative decompression method for MLBO.

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“…In addition, time to resume oral food intake was shorter in the stent group. Despite its controversial use in right-sided colonic obstruction, a recent meta-analysis confers that stenting as a bridge to surgery results in a reduction of postoperative complications and mortality for right-sided malignant large bowel obstruction than emergency resection ( 43 ).…”

Section: Discussionmentioning

confidence: 99%

Case report: Stent-first strategy as a potential approach in the management of malignant right-sided colonic obstruction with cardiovascular risks

et al. 2022

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In obstructing left-sided colonic or rectal cancer, endoscopic stent placement with the purpose of decompression and bridge to elective colon resection has been widely utilized and accepted. However, in malignant right-sided colonic obstruction, stent placement prior to colectomy is still highly controversial, due to lower clinical success and high anastomotic leak. We report a case of malignant right-sided colonic obstruction based on the radiological findings of irregular thickening of ascending colon wall and dilation of proximal large bowel on enhanced computed tomography scan. The 72-year-old woman presented with obvious abdominal distension. Due to concerning cardiovascular complications as intermittent chest pain and a long history of type 2 diabetes, a three-step therapeutic plan was instigated. Initially, a self-expandable metallic stent was placed palliatively to relieve the bowel obstruction. Consecutively, coronary angiography was performed, and two coronary stents were implanted to alleviate more than 80% stenosis of two main coronary arteries. One month later, laparoscopic radical resection of right colon and lymphadenectomy were successfully performed, with a blood loss less than 50 millimeters and a harvest of 29 lymph nodes, 1 being positive. The patient was discharged one week postoperatively with no complications, and received adjuvant chemotherapy one month later. During a follow-up of more than one year, the patient was in complete remission with no recurrence and cardiovascular events. In patients presenting with malignant right-sided colonic obstruction and peril of high cardiovascular risks, we propose colonic and coronary stent-first strategy to emergency surgery as a potential approach so as to ensure sufficient cardiovascular preparation improving perioperative safety. Moreover, the anatomical location of the tumor would be significantly achievable thus granting high-quality radical colon resection and lymphadenectomy.

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Colonic stent as a bridge to surgery versus emergency resection for right-sided malignant large bowel obstruction: a meta-analysis

Cited by 14 publications

References 42 publications

Comparison of Short-term Outcomes of a Self-expandable Metallic Stent as a Bridge to Laparoscopic Surgery between Right- and Left-sided Obstructive Colorectal Cancers: A Retrospective Observational Study

Comparison of Short-term Outcomes of a Self-expandable Metallic Stent as a Bridge to Laparoscopic Surgery between Right- and Left-sided Obstructive Colorectal Cancers: A Retrospective Observational Study

Long‐term outcomes between self‐expandable metallic stent and transanal decompression tube for malignant large bowel obstruction: A multicenter retrospective study and meta‐analysis

Case report: Stent-first strategy as a potential approach in the management of malignant right-sided colonic obstruction with cardiovascular risks

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