Emergency preoperative stenting versus surgery for acute left-sided malignant colonic obstruction: a multicenter randomized controlled trial

Pirlet, I.; Slim, K.; Kwiatkowski, Fabrice; Michot, F; Millat, Bertrand

doi:10.1007/s00464-010-1471-6

Cited by 291 publications

(241 citation statements)

References 20 publications

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“…Such stoma-avoidance advantage of stenting in comparison to emergency surgery ( 33,34 ) has been widely demonstrated with the exception of a study by Pirlet et al . ( 35 ) in which there was no statistically signifi cant diff erence in stoma rate between patients who received a SEMS (43%) and those who did not (57%) prior to surgery. However, all stomas from the SEMS arm were done in technical-failure patients who actually underwent emergency surgery, whereas the majority of successfully stented patients had the benefi t of elective colonic resection and primary anastomosis with an uneventful postoperative course.…”

Section: Discussionmentioning

confidence: 90%

Colonic Stenting as a Bridge to Surgery in Malignant Large-Bowel Obstruction: A Report from Two Large Multinational Registries

Jiménez-Perez

Casellas

García-Cano

et al. 2011

American Journal of Gastroenterology

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OBJECTIVES:To date, this is the largest prospective series in patients with malignant colorectal obstruction to evaluate the effectiveness and safety of colonic self-expanding metal stents (SEMSs) as an alternative to emergency surgery. SEMSs allow restoration of bowel transit and careful tumor staging in preparation for elective surgery, hence avoiding the high morbidity and mortality associated with emergency surgery and stoma creation. METHODS:This report is on the SEMS bridge-to-surgery subset enrolled in two multicenter international registries. Patients were treated per standard of practice, with documentation of clinical and procedural success, safety, and surgical outcomes. RESULTS:A total of 182 patients were enrolled with obstructive tumor in the left colon (85 % ), rectum (11 % ), or splenic fl exure (4 % ). Of these patients, 86 % had localized colorectal cancer without metastasis. Procedural success was 98 % (177 / 181). Clinical success was 94 % (141 / 150). Elective surgery was performed in 150 patients (9 stomas) and emergency surgery in 7 patients for treatment of a complication (3 stomas). The overall complication rate was 7.8 % (13 / 167), including perforation in 3 % (5 / 167), stent migration in 1.2 % (2 / 167), bleeding in 0.6 % (1 / 167), persistent colonic obstruction in 1.8 % (3 / 167), and stent occlusion due to fecal impaction in 1.2 % (2 / 167). One patient died from complications related to surgical management of a perforation.CONCLUSIONS: SEMSs provide an effective bridge to surgery treatment with an acceptable complication rate in patients with acute malignant colonic obstruction, restoring luminal patency and allowing elective surgery with primary anastomosis in most patients.

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Section: Discussionmentioning

confidence: 90%

Colonic Stenting as a Bridge to Surgery in Malignant Large-Bowel Obstruction: A Report from Two Large Multinational Registries

Jiménez-Perez

Casellas

García-Cano

et al. 2011

American Journal of Gastroenterology

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“…There was no difference between SEMS arm and emergent surgery in primary anastomosis, permanent stoma, in-hospital mortality, anastomotic leak, 30-day reoperation and surgical-site infection rates [82][83][84][85].…”

Section: Colonic Stent Placementmentioning

confidence: 86%

Complications of Colonoscopy

Waye

Aisenberg

Rubin

2013

Practical Colonoscopy

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“…15 This guideline is based on the evidence from eight systematic reviews with meta-analysis comparing preoperative stenting with emergency resection for left-sided colonic malignant obstruction, 11,[36][37][38][39][40][41][42] with assimilated data from up to seven RCTs. [43][44][45][46][47][48][49] Three of those RCTs were closed early due to adverse outcomes in the SEMS group (higher 30-day morbidity related to stent perforation), 43,44 or high anastomotic leak rate in the emergency surgery group. 48 The most recently published meta-analysis found that SEMS as a bridge to surgery (n = 195) compared to emergency surgery (n = 187) had a lower overall morbidity (33.1% vs 53.9%, P = 0.03), a higher successful primary anastomosis rate (67.2% vs 55.1%, P < 0.01), and a lower permanent stoma rate (9% vs 27.4%, P < 0.01); however, there was no statistical difference in post-operative mortality (10.7% vs 12.4%).…”

Section: Sems As a Bridge To Elective Surgerymentioning

confidence: 99%

“…13 Manipulation of the tumour by the shearing forces of endoscopy and colonic insufflation is thought to disseminate tumour cells locally and into the circulation. 43 Three RCTs have investigated long-term oncological outcome, all the sample sizes were small (15-26 patients in the SEMS groups), and found increased disease recurrence in the SEMS groups.…”

Section: Sems As a Bridge To Elective Surgerymentioning

confidence: 99%

Colonic cancer: The current role of stent insertion

Newton

Hill

2017

Int J Gastrointest Interv

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Acute colonic obstruction secondary to left-colonic malignancy remains a common emergency condition. Traditional management is emergency surgery and has high morbidity and mortality. Self expandable metallic stents (SEMS) promised to improve morbidity and mortality, stoma rates and hospital stay. SEMS use in the potentially curative setting, as a bridge to surgery, is associated with an improved stoma rate and morbidity, but has no mortality benefit. There are concerns about oncological safety with higher local recurrence rates, thus SEMS is not recommended in this setting unless the patient has increased surgical risk and would benefit from a period of recovery prior to surgery. SEMS has a definite role in the palliative setting, for both patients with incurable disease or those with a high surgical risk. SEMS is associated with improved morbidity, mortality, and stoma rates. The technique for SEMS insertion is now well established but it is still unclear whether covered or uncovered stents are better.

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Emergency preoperative stenting versus surgery for acute left-sided malignant colonic obstruction: a multicenter randomized controlled trial

Abstract: This randomized trial failed to demonstrate that emergency preoperative SEMS for patients presenting with acute left-sided malignant colonic obstruction could significantly decrease the need for stoma placement.

Cited by 291 publications

References 20 publications

Colonic Stenting as a Bridge to Surgery in Malignant Large-Bowel Obstruction: A Report from Two Large Multinational Registries

Colonic Stenting as a Bridge to Surgery in Malignant Large-Bowel Obstruction: A Report from Two Large Multinational Registries

Complications of Colonoscopy

Colonic cancer: The current role of stent insertion

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