Oncological Assessment of Stent Placement for Obstructive Colorectal Cancer from Circulating Cell-Free DNA and Circulating Tumor DNA Dynamics

Takahashi, Goro; Yamada, Takeshi; Iwai, Takuma; Takeda, Kohki; Koizumi, Michihiro; Shinji, Seiichi; Uchida, Eiji

doi:10.1245/s10434-017-6300-x

Cited by 66 publications

(58 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In addition, stent insertion for obstructive CRC may result in an increase in CK20 mRNA [21], cell-free DNA, circulating tumor DNA [24], and viable circulating tumor cells (v-CTCs) [25]. To accurately evaluate the effect of tumor manipulation by the radial force generated when a SEMS expands, the influence of additional surgery, such as colostomy, should be avoided as much as possible.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

View full text Add to dashboard Cite

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

show abstract

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

View full text Add to dashboard Cite

show abstract

“…A multicentre retrospective study also indicated that the long-term oncologic outcome of the SEMS group was similar or slightly better than that of the ES group among all patients with stage II or III colon cancer [23]. Moreover, a recent study reported that SEMS placement increased plasma levels of cell-free DNA and circulating tumour DNA by tumour manipulation [24], although several clinical studies reported no signi cant differences in the long-term survival rates regardless of stent placement before surgery [25,26]. Moreover, Li et al and Gianotti et al reported improved survival of the SEMS group throughout the follow-up period [27,28].…”

Section: Discussionmentioning

confidence: 95%

Self-expandable metallic stenting as a bridge to elective surgery versus emergency surgery for acute malignant right-sided colorectal obstruction

Cai

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Data are limited regarding the advantages of a self-expandable metal stent (SEMS) as a bridge to elective surgery for acute malignant obstruction of the right-sided colon (MORC), as most studies concentrated on this technique used in left-sided colon. This study aimed to evaluate the outcomes of patients (including stage IV cases) with acute MORC treated by initial SEMS placement vs emergency surgery (ES). Methods Patients with acute MORC who underwent radical resection for a primary tumour from July 2008 to November 2016 at Zhongshan Hospital of Fudan University were retrospectively enrolled. Postoperative short-term outcomes, progression-free survival (PFS), and overall survival (OS) were compared between the SEMS and ES groups. Results In total, 107 patients with acute MORC (35 in the SEMS group and 72 in the ES group) were included for analysis. The Intensive Care Unit admission rate was lower (11.4% vs. 34.7%, P = 0.011), the incidence of complications was reduced (11.4% vs. 29.2%, P = 0.042), and the postoperative length of hospitalisation was significantly shorter (8.23 ± 6.50 vs. 11.18 ± 6.71 days, P = 0.033) for the SEMS group. Survival curves showed no significant difference in PFS (P = 0.506) or OS (P = 0.989) between groups. 29.0% (27/93) of the patients with stage II and III disease experienced disease progression, when the distant metastasis rates for the SEMS and ES groups were 21.4% (6/28) and 18.5% (12/65), respectively (P = 0.740) and local site relapse presented in 2 (7.1%) patients of the SEMS group and in 7 (10.8%) patients of the ES group (P = 0.719). After colectomy for synchronous liver metastases, the hepatectomy rates for the SEMS and ES groups were 85.7% and 14.3%, respectively (P = 0.029). The hazard ratio for colectomy alone vs combined resection was 3.258 (95% CI 0.858–12.370; P = 0.041). Conclusion Stent placement offers significant advantages in terms of short-term outcomes and comparable prognoses for acute MORC patients. For synchronous liver metastases, SEMS placement better prepares the patient for resection of the primary tumour and liver metastasis, which contribute to improved survival.

show abstract

“…Since the rst reported use of SEMS in 1991, SEMS as a bridge of surgery has been widely developed because of its good short-term results, but its longterm oncology results are worrying (31). Several studies (32)(33)(34)(35) have found that SEMS implantation can cause tumor cells to release into the circulatory system, but Ishibashi (32) believes that these tumor cells are not cancer stem-like cells, which can be quickly removed by the body, so they will not cause distant metastasis of the tumor.…”

Section: Discussionmentioning

confidence: 99%

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

Fan

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: To explore the long-term oncological safety of using self-expanding metal stents(SEMS) as a bridge to surgery for acute obstructive colorectal cancer by comparing the pathological results of emergency surgery(ES) with elective surgery after the placement of SEMS. Methods: Studies comparing SMES as a bridge to surgery with emergency surgery for acute obstructive colorectal cancer were retrieved through the databases of Pubmed, Embase, and Cochrane libraries, and a meta-analysis was conducted based on the pathological results of the two treatments. Risk ratios(OR) or mean differences(MD) with 95% confidence intervals(CI) were calculated for the outcomes under random effects model. Results: A total of 27 studies were included, including 3 randomized controlled studies, 2 prospective studies, and 22 retrospective studies, with a total of 3737 patients. The presence ofperineural invasion(RR=0.58, 95% CI=0.48, 0.71, P<0.00001), lymphovascular invasion(RR=0.68, 95%CI=0.47,0.99, P=0.004) and vascular invasion(RR=0.66, 95%CI=0.45,0.99, P=0.04) in SEMS group were significantly higher than those in ES group, and there was no significant difference in lymphatic invasion(RR=0.92, 95%CI=0.77,1.09, P=0.33). The number of lymph nodes harvested in SEMS group was significantly higher than that in ES group(MD=-3.18, 95% CI=-4.47,-1.90, P<0.00001). While no significant difference was found in the number of positive lymph nodes(MD=-0.11, 95%CI=-0.63,0.42, P=0.69) and N stage[N0(RR=1.03, 95%CI=0.92,1.15, P=0.60), N1(RR=0.99, 95%CI=0.87,1.14, P=0.91), N2(RR=0.94, 95%CI=0.77,1.15, P=0.53)]. Conclusions: SEMS implantation in patients with acute malignant obstructive colorectal cancer may lead to an increase in adverse tumor pathological characteristics, and these characteristics are mostly related to the poor prognosis of colorectal cancer. Although the adverse effect of SEMS on long-term survival has not been demonstrated, it should not be considered as the first treatment for radically resectable colorectal cancer.

show abstract

Oncological Assessment of Stent Placement for Obstructive Colorectal Cancer from Circulating Cell-Free DNA and Circulating Tumor DNA Dynamics

Abstract: Despite equivalent clinical success rates, SEMS placement increased plasma levels of cfDNA and ctDNA by tumor manipulation, but TDT did not. Colonic stenting showed oncological risk in terms of molecular analysis.

Cited by 66 publications

References 26 publications

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

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

Self-expandable metallic stenting as a bridge to elective surgery versus emergency surgery for acute malignant right-sided colorectal obstruction

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

Contact Info

Product

Resources

About