Determining the difference in the efficacy and safety of self-expandable metallic stents as a bridge to surgery for obstructive colon cancer among patients in the CROSS 0 group and those in the CROSS 1 or 2 group: a pooled analysis of data from two Japanese prospective multicenter trials

Abstract

Purpose This study compared the feasibility and safety of endoscopic placement of self-expandable metallic stents (SEMSs) as a bridge to surgery (BTS) between patients with obstructive colorectal cancer (CRC) classified as ColoRectal Obstruction Scoring System (CROSS) 0 and those with CROSS 1 or 2. Methods We conducted a post hoc analysis of two prospective, observational, single-arm multicenter clinical trials and performed a pooled analysis of the data. In total, 336 consecutive patients with malignant colorectal obstruction underwent SEMS placement. The primary endpoint was clinical success, defined as resolution of symptoms and radiological findings within 24 h. Secondary endpoints were technical success and adverse events. Results High clinical (98.0% vs. 98.4%) and technical (96.7% vs. 97.8%) success rates were observed in both groups (CROSS 0 vs. CROSS 1 or 2). The adverse event rate was low. The mean stricture length was lower (3.8 ± 1.2 cm vs. 4.4 ± 1.8 cm) and laparoscopic surgery more common (56.7% vs 52.2%) in the CROSS 0 group than in the CROSS 1 and 2 group. Conclusion This study was the first to compare the degree of stricture in different CROSS groups and demonstrated comparable results with respect to the short-term efficacy and safety of SEMS placement as a BTS for obstructive CRC in CROSS 0, 1, and 2 patients. Keywords Colorectal cancer • Colorectal obstruction • Bridge to surgery • Self-expandable metallic stents • Pooled analysis Abbreviations ASA American Society of Anesthesiologists BTS Bridge to surgery COBRA Colonic stent for "Bridge to Surgery" prospective randomized controlled trial comparing treatment with non-stenting surgery in stage II/III obstructive colon cancer CRC

Utility and safety of the self‐expandable metallic colonic stent in Japanese patients who received systemic chemotherapy or palliative treatment for obstructive primary advanced colorectal cancer: A retrospective single‐center medical chart evaluation

“…The utility of colonic stenting has mainly been evaluated on the basis of the surgical outcomes, including long‐term survival and postoperative complications, of Japanese patients who were bridged for curative surgery 2–6,9 . The present study suggests that colonic stenting for decompression for obstructive colorectal cancer is as valuable and effective in patients who undergo systemic chemotherapy and palliative therapy as it is in patients who are bridged for curative surgery, which are partly supported by the findings of previous studies 7,12 …”

“…2,3 Decompression by colonic stenting for stenosis in advanced colorectal cancer has been used during bridging before curative surgery and systemic chemotherapy. 3,[5][6][7][8][9][10][11] The technical-and patient-related risk factors for colonic stenting have been identified in several Japanese studies in the last 3 years. [12][13][14][15][16][17] Regarding surgical outcomes, the advantages and disadvantages of colonic stenting for bridging for surgery were compared with those for emergency surgery and the trans-anal decompression tube in Japanese studies and were found to be controversial.…”

“…Regarding surgical outcomes, the advantages and disadvantages of colonic stenting for bridging for surgery were compared with those for emergency surgery and the trans‐anal decompression tube in Japanese studies and were found to be controversial 18–22 . Several studies that focused on the clinical safety and effectiveness of the self‐expandable colonic stent have been conducted in the last 3 years in Japan, most of which were limited to advanced colon cancer patients who were bridged before surgical curative therapy 1–3,5–11 . The present study aimed to compare the utility (technical and clinical success rates) and the safety (rate of early and late complications after stent placement) of the colonic stent between patients who received systemic chemotherapy or palliative treatment and the best supportive care and patients who were bridged for surgery.…”

Self-expandable metal stent (SEMS) placement or emergency surgery as palliative treatment for obstructive colorectal cancer: A systematic review and meta-analysis

“…Within this scoring system ranging from CROSS 0-2, a lower ability to eat soft solids results in a lower CROSS score. A recently pooled, post-hoc analysis of two prospective observational multicenter studies evaluated stricture degree in CROSS 0 (worse clinical state) versus CROSS 1 or 2 patients treated with SEMS as BTS (Ohki et al, 2020). Both clinical effectiveness and safety of SEMS were similar between CROSS 0 and CROSS 1 or 2 patients.…”

Outcomes of Patients with Left-Sided Obstructive Colorectal Cancer: Comparison between Self-Expandable Metallic Stent and Other Treatment Methods

“…Additionally, ER of a primary tumour is still performed frequently for left-sided OCRC in a curative setting [7], and the effectiveness of DS as a BTS is also reported [8]. Recently, SEMS is increasingly used as a BTS [9, 10]. Although the advantages of these methods have been reported, the optimal treatment strategy for left-sided OCRC patients remains controversial.…”