Does stenting of left-sided colorectal cancer as a “bridge to surgery” adversely affect oncological outcomes? A comparison with non-obstructing elective left-sided colonic resections

Abstract

In our own practice, patients undergoing SEMS as a "bridge to surgery" have the same long-term survival with those undergoing elective surgery. This finding needs to be confirmed in larger scale studies.

Stent as bridge to surgery for left-sided malignant colonic obstruction reduces adverse events and stoma rate compared with emergency surgery: results of a systematic review and meta-analysis of randomized controlled trials

“…Morbidity was defined as the occurrence of any adverse event directly or indirectly related to endoscopy and/or surgery. Secondary Full text articles and abstracts assessed for eligibility (8) Full-text articles and abstracts excluded (n=30) with reasons: endpoints were the success of stent positioning, its safety, ie, postprocedural adverse events including bleeding and perforation, the need for surgery to manage adverse events, need for a stoma, operative time, hospital length of stay, cost analysis, oncologic outcome, and quality of life.…”

“…7 Moreover, concern has been expressed regarding the effect of colonic stenting on short-term adverse events, as well as on long-term survival in patients whose disease is potentially curable, because of the possible risk of both local progression of the cancer and metastatic spread. 8,9 We performed a systematic review of the literature comparing colonic stenting as bridge to surgery (SBTS) and emergency surgery (ES) and a meta-analysis to determine whether the SBTS strategy confers clinically relevant short-term advantages in terms of morbidity over ES in the treatment of symptomatic left-sided malignant colonic obstruction.…”

Stentimplantation beim Dickdarmileus – eine Chance mit Risiko

“…Die Aussagen dazu sind unterschiedlich [32]. Ein Stent erscheint durchaus gerechtfertigt [17], aber auch die Möglichkeit der laparoskopischen Resektion ist in der Literatur beschrieben [19,24]. Das Prinzip "bridge to surgery" bietet die Vorteile der geringeren kurzzeitigen Belastung kombiniert mit einer höheren primären Anastomosenrate ohne Stoma [3].…”

Kolonstents als «Bridge to Surgery»

“…Bei der Vorbereitung und Durchführung einer Stentimplantation sind erfahrungsgemäß erhebliche mechanische Irritationen direkt am Tumor unvermeidlich; tritt gar eine silente oder overte Perforation (in den Studien im Mittel bei 5–15%, im Extrem zwischen 1 und mehr als 60% [30] aller Stentpatienten) auf, muss dies als onkologische Katastrophe betrachtet werden (Tumorperforation gilt als T 4 -Kriterium!). Auch wenn in rein klinischen Verlaufsstudien [31] bei kleinen Patientenzahlen (n = 15!) kein nachteiliger Effekt des Stenting auf das Langzeitüberleben gefunden wurde, bleiben die genannten Argumente relevant.…”