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

Abstract

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.

Comparison of safety between self-expanding metal stents as a bridge to surgery and emergency surgery based on pathology: a meta-analysis

“…A recent literature review showed that only a small number of studies showed that the placement of SEMS may affect the long-term surgical outcomes, and most studies showed that SEMS did not have a negative impact on the patients’ long-term survival and prognosis [ 59 ]. Two recent meta-analyses respectively summarize the data of 2508 patients and 15,224 patients, the results showed no significant difference between SEMS and ES in terms of three-year OS and three-year DFS, or five-year OS and five-year DFS, which was consistent with the results of previous meta-analysis [ 59 – 61 ]. However, given the relatively small proportion of randomized controlled studies (20.8% and 26.7% respectively), and the factors such as stent placement technology and stent type can not be standardized, and due to the possible influence of factors such as chemotherapy and surgical interval mentioned above, the absence of significant differences in long-term surgical outcomes should be interpreted with caution.…”

“…In the study of cancer recurrence and disease-free survival rate, etc., the results were also contradictory. Most scholars [ 20 , 36 – 37 ] have not observed the difference between the SEMS group and the ES group, while Gorissen [ 11 ] believed that SEMS can increase the local recurrence rate of cancer. Sabbagh [ 27 ] found the SEMS group was inferior to the ES group in long-term outcomes such as overall survival and cancer-specific mortality apparently.…”

Comparison of safety between self-expanding metal stents as a bridge to surgery and emergency surgery based on pathology: a meta-analysis

“…In the study of cancer recurrence and disease-free survival rate, etc., the results were also contradictory. Most scholars (20,(36)(37) have not observed the difference between the SEMS group and the ES group, while Gorissen (11) believed that SEMS can increase the local recurrence rate of cancer. Sabbagh (27) found the SEMS group was inferior to the ES group in long-term outcomes such as overall survival and cancerspeci c mortality apparently.…”

Comparison of the Oncological Outcomes of Stenting as a Bridge to Surgery and Surgery Alone in Stages II-III Obstructive Colorectal Cancer; A Retrospective Study

“…A meta-analysis by Ceresoli et al in 2017 reported that stents such as BTS had no adverse effects on the 3-year or 5-year mortality rates or on local recurrence [16]. Recently, 2 meta-analyses revealed no signi cant difference between the stent group and the emergency surgery group in terms of overall survival, disease-free survival, and recurrence [13,17]. In 2016, the multicenter, randomized controlled ESCO trial reported no difference in the 3-year overall survival and progression-free survival rates between the colonic stenting (BTS group) and the emergency surgery group [18].…”

“…In 2019, the Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines stated that obstruction relief by stent treatment as part of a BTS premised on curative surgical removal may also cause perforation and other adverse effects, which may worsen the long-term prognosis [12]. However, this has not been con rmed by recent meta-analyses [13]. In 2020, the European Society of Gastrointestinal Endoscopy guidelines recommended that stenting as a BTS be discussed as part of a shared decision-making process as a treatment option in patients with potentially curable left-sided obstructing colon cancer as an alternative to emergency resection [14].…”