Emergency resection versus bridge to surgery with stenting in patients with acute right-sided colonic obstruction: a systematic review focusing on mortality and morbidity rates

Amelung, Femke J.; Beaufort, Hector W.L. de; Siersema, Peter D.; Verheijen, Paul M.; Consten, Esther C. J.

doi:10.1007/s00384-015-2216-8

Cited by 48 publications

(32 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In addition, stenting was associated with lower morbidity rates and fewer permanent stomas. These retrospective results are similar and supportive to those found is our prospective analysis 15. However, these data should be interpreted with caution, because all included studies in the systematic review were cohort studies.…”

Section: Discussionsupporting

confidence: 89%

A Population-Based Analysis of Three Treatment Modalities for Malignant Obstruction of the Proximal Colon: Acute Resection Versus Stent or Stoma as a Bridge to Surgery

Amelung

Consten

Siersema³

et al. 2016

Ann Surg Oncol

Self Cite

View full text Add to dashboard Cite

BackgroundMalignant obstruction of the proximal colon (MOPC) traditionally has been treated with acute resection. However, morbidity and mortality rates following these emergency surgeries are high. Initial bowel decompression by stent placement or stoma construction has been used for distal obstructions as an alternative approach. This study evaluated whether these alternative treatment strategies could be beneficial for patients with a MOPC as well.MethodsAll patients undergoing a colonic resection for a MOPC between January 2009 and December 2013 and who were registered in the Dutch Surgical Colorectal Audit were analyzed.ResultsFrom the 49,013 patients registered in the DSCA, 1860 (3.8 %) were selected for further analysis. Acute resection was performed in 1774 patients (95.4 %), 44 patients (2.4 %) were treated with initial decompression using stent placement and resection, and 42 patients (2.3 %) with stoma construction followed by resection. Thirty-day mortality was 8.8, 2.4, and 2.4 %, respectively. Mortality was significantly lower after a bridging strategy (stent or stoma) compared with acute resection (p = 0.04). Complications following the resection occurred in 39.6% in the acute resection group and in 27.3 and 31.7% in the stent and stoma group, respectively (p = 0.167).ConclusionsAcute resection was performed in the vast majority of patients with obstructive proximal colon cancer and resulted in a 40 % morbidity and 9 % mortality rate. A bridging strategy may be a valid alternative in some of these patients, because a significantly lower postoperative mortality rate was seen in a subgroup of patients initially treated with a stent or stoma.

show abstract

Section: Discussionsupporting

confidence: 89%

A Population-Based Analysis of Three Treatment Modalities for Malignant Obstruction of the Proximal Colon: Acute Resection Versus Stent or Stoma as a Bridge to Surgery

Amelung

Consten

Siersema³

et al. 2016

Ann Surg Oncol

Self Cite

View full text Add to dashboard Cite

show abstract

“…Ceresoli et al compared long-term oncologic outcomes of SBTS and ES in malignant left-sided colonic obstructions, and they thought there were no significant differences reported in local and overall recurrence rates [61]. Amelung et al compared procedure-related mortality and morbidity rates between primary resection and stent placement as a bridge to surgery followed by elective resection for patients with acute right-sided colonic obstruction (RSCO), and they thought primary resection for patients with acute RSCO seems to be associated with higher mortality and major morbidity rates than stent placement and elective resection [62]. Other meta-analyses compared the long-term outcomes of stents as BTS and emergency sur-gery and found that BTS was oncologically comparable with emergency surgery with respect to OS, DFS, and recurrence, and there was no difference in long-term tumour outcomes [22,[63][64][65][66].…”

Section: Discussionmentioning

confidence: 99%

Long-term tumour outcomes of self-expanding metal stents as ‘bridge to surgery’ for the treatment of colorectal cancer with malignant obstruction: a systematic review and meta-analysis

Cao

Deng

et al. 2019

Int J Colorectal Dis

View full text Add to dashboard Cite

Purpose To explore the long-term oncological results of self-expanding metal stents (SEMS) as a surgical transition compared with those of simple emergency surgery. Methods A systematic review of studies involving long-term tumour outcomes comparing SEMS with emergency surgery was conducted. All studies included information on 3-year and 5-year survival rates, 3-year and 5-year disease-free survival (DFS) rates, and local and overall recurrence rates; the results were expressed as odds ratios. Results Overall, 24 articles and 2508 patients were included, including 5 randomised controlled trials, 3 prospective studies, and 16 retrospective studies. The 3-year survival rate (odds ratio (OR) = 0.88, 95% confidence interval (CI) 0.69-1.12, P = 0.05), 5-year survival rate (OR = 0.91, 95% CI 0.70-1.17, P = 0.67), 3-year DFS rate (OR = 1.14, 95% CI 0.91-1.42, P = 0.65), 5-year DFS rate (OR = 1.35, 95% CI 0.91-2.02, P = 0.17), overall recurrence rate (OR 1.04, 95% CI 0.77-1.41, P = 0.14), and local recurrence rate (OR 1.37, 95% CI 0.84-2.23, P = 0.92) were determined. There was no significant difference between the randomised and observational studies in the subgroup analysis, and the 5-year survival rate was higher in studies with a stent placement success rate of ≥ 95%. Conclusion SEMS implantation was a viable alternative in malignant left colon obstruction as a transition to surgery; its longterm survival results, including 5-year DFS and overall survival, were equivalent to those of emergent surgery.

show abstract

“…In a recent multicenter retrospective study [ 169 ], the most appropriate treatment approach for patients with ORCC was evaluated, by comparing short-term postoperative outcomes and long-term oncologic outcomes after ES (emergency surgery), and BTS short-term and long-term outcomes in the BTS group were not inferior to those in the ES group. Right colon stenting is considered technically challenging and future comparative studies are needed for the development of an evidence-based recommendation for clinical decision-making [ 170 ].…”

Section: Management Of Obstruction: Right Colonmentioning

confidence: 99%

2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation

et al. 2018

View full text Add to dashboard Cite

ᅟObstruction and perforation due to colorectal cancer represent challenging matters in terms of diagnosis, life-saving strategies, obstruction resolution and oncologic challenge. The aims of the current paper are to update the previous WSES guidelines for the management of large bowel perforation and obstructive left colon carcinoma (OLCC) and to develop new guidelines on obstructive right colon carcinoma (ORCC).MethodsThe literature was extensively queried for focused publication until December 2017. Precise analysis and grading of the literature has been performed by a working group formed by a pool of experts: the statements and literature review were presented, discussed and voted at the Consensus Conference of the 4th Congress of the World Society of Emergency Surgery (WSES) held in Campinas in May 2017.ResultsCT scan is the best imaging technique to evaluate large bowel obstruction and perforation. For OLCC, self-expandable metallic stent (SEMS), when available, offers interesting advantages as compared to emergency surgery; however, the positioning of SEMS for surgically treatable causes carries some long-term oncologic disadvantages, which are still under analysis. In the context of emergency surgery, resection and primary anastomosis (RPA) is preferable to Hartmann’s procedure, whenever the characteristics of the patient and the surgeon are permissive. Right-sided loop colostomy is preferable in rectal cancer, when preoperative therapies are predicted.With regards to the treatment of ORCC, right colectomy represents the procedure of choice; alternatives, such as internal bypass and loop ileostomy, are of limited value.Clinical scenarios in the case of perforation might be dramatic, especially in case of free faecal peritonitis. The importance of an appropriate balance between life-saving surgical procedures and respect of oncologic caveats must be stressed. In selected cases, a damage control approach may be required.Medical treatments including appropriate fluid resuscitation, early antibiotic treatment and management of co-existing medical conditions according to international guidelines must be delivered to all patients at presentation.ConclusionsThe current guidelines offer an extensive overview of available evidence and a qualitative consensus regarding management of large bowel obstruction and perforation due to colorectal cancer.

show abstract

Emergency resection versus bridge to surgery with stenting in patients with acute right-sided colonic obstruction: a systematic review focusing on mortality and morbidity rates

Cited by 48 publications

References 36 publications

A Population-Based Analysis of Three Treatment Modalities for Malignant Obstruction of the Proximal Colon: Acute Resection Versus Stent or Stoma as a Bridge to Surgery

A Population-Based Analysis of Three Treatment Modalities for Malignant Obstruction of the Proximal Colon: Acute Resection Versus Stent or Stoma as a Bridge to Surgery

Long-term tumour outcomes of self-expanding metal stents as ‘bridge to surgery’ for the treatment of colorectal cancer with malignant obstruction: a systematic review and meta-analysis

2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation

Contact Info

Product

Resources

About