Outcomes following colonic stenting for malignant left-sided bowel obstruction: a systematic review of randomised controlled trials

Boland, Patrick A; Kelly, Michael E.; Donlon, Noel E; Rausa, Emanuele; Beddy, David; McCormick, Paul; Mehigan, Brian; Larkin, John

doi:10.1007/s00384-019-03378-z

Cited by 24 publications

(22 citation statements)

References 34 publications

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“…Data regarding mortality greatly vary among the different published systematic reviews [31][32][33][34][35][36][37]. However, the most recent meta-analyses on this topic seem to be in line with our results, demonstrating a benefit in terms of mortality rates with the use of SEMS when compared to ES [38,39].…”

Section: Discussionsupporting

confidence: 86%

Current Status of the Self-Expandable Metal Stent as a Bridge to Surgery Versus Emergency Surgery in Colorectal Cancer: Results from an Updated Systematic Review and Meta-Analysis of the Literature

Cirocchi

Arezzo

Sapienza³

et al. 2021

Medicina

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Background: The current use of endoscopic stenting as a bridge to surgery is not always accepted in standard clinical practice to treat neoplastic colonic obstructions. Objectives: The role of colonic self-expandable metal stent (SEMS) positioning as a bridge to resective surgery versus emergency surgery (ES) for malignant obstruction, using all new data and available variables, was studied and we focused on short- and long-term results. Materials and Methods: A systematic review with meta-analysis was performed. PubMed, SCOPUS and Web of Science databases were included. The search comprised only randomized controlled trials (RCTs) investigating the interventions that included SEMS positioning versus ES. The primary outcomes were the rates of overall postoperative mortality, clinical and technical success. The secondary outcomes were the short- and long-term results. Results: A total of 12 studies were eligible for further analyses. A laparoscopic colectomy was the most common operation performed in the SEMS group, whereas the traditional open approach was commonly used in the ES group. Intraoperative colonic lavage was seldomly performed during ES. There were no differences in mortality rates between the two groups (RR 1.06, 95% CI 0.55 to 2.04; I2 = 0%). In the SEMS group, the rate of successful primary anastomosis was significantly higher in of SEMS (69.75%) than in the ES (55.07%) (RR 1.26, 95% 245 CI 1.01 to 1.57; I2 = 86%). Conversely, the upfront Hartmann procedure was performed more frequently in the ES (39.1%) as compared to the SEMS group (23.4%) (RR 0.61, 95% CI 0.45 to 0.85; I2 = 23%). The overall postoperative complications rate was significantly lower in the SEMS group (32.74%) than in the ES group (48.25%) (RR 0.61, 95% CI 0.41 to 0.91; I2 = 65%). Conclusions: In the presence of malignant colorectal obstruction, SEMS is safe and associated with the same mortality and significantly lower morbidity than the ES group. The rate of successful primary anastomosis was significantly higher than the ES group. Nevertheless, recurrence and survival outcomes are not significantly different between the two groups. The analysis of short- and long-term results can suggest the use of SEMS as a bridge to resective surgery when it is performed by an endoscopist with adequate expertise in both colonoscopy and fluoroscopic techniques and who performed commonly colonic stenting.

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Section: Discussionsupporting

confidence: 86%

Current Status of the Self-Expandable Metal Stent as a Bridge to Surgery Versus Emergency Surgery in Colorectal Cancer: Results from an Updated Systematic Review and Meta-Analysis of the Literature

Cirocchi

Arezzo

Sapienza³

et al. 2021

Medicina

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“…In terms of long-term outcomes, the SEMS plus elective surgery did not lead to a significant improvement in 3-year survival compared with emergency surgery alone, based on PP and ITT analyses. As summarized in Table 4, our results were similar to those described in most of the previous systematic reviews and meta-analyses [4,[16][17][18][19][20][21][22][23][24][25][26][27][28][29]. However, some controversy remains with regards to the short-and long-term impact of the SEMS as a bridge to surgery.…”

Section: Emergency Medicine Internationalsupporting

confidence: 88%

Fluoroscopic Stenting as a Bridge to Surgery versus Emergency Management for Malignant Obstruction of the Colon

Lin

Zhou

Feng

et al. 2020

Emergency Medicine International

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Aim. To investigate the feasibility of a SEMS (self-expandable metallic stent) as a bridge to surgery for malignant colonic obstruction. Methods. We retrospectively reviewed 83 patients that were in accordance with inclusion criteria; of these, 33 patients that underwent fluoroscopy-guided SEMS placement followed by elective curative resection were classified as a SEMS group and 50 patients, who received emergency surgery (ES), were classified as an ES group. The clinicopathological characteristics, surgery-related parameters, complications, and three-year survival rate were compared between the two groups. Results. No significant differences between the two groups were observed in any of the clinicopathologic characteristics except for higher preoperative absolute neutrophil count in the ES group (P<0.001). Compared to the ES group, the SEMS group has significantly more cases, which featured a laparoscopic approach (72.7% vs. 14.0%, P<0.001), lower overall stoma rate (0% vs. 34.0%, P<0.001), and lower overall postoperative morbidity (27.3% vs. 56.0%, P=0.010). The oncological outcomes did not differ significantly between the two groups in terms of three-year overall survival (P=0.125). The technical and clinical success rates of stent placement were 91.7% and 100%, respectively. Conclusion. Patients treated with the stent-surgery approach had significant short-term superiorities and similar long-term outcomes, compared to patients who had emergency surgery alone. The SEMS is, therefore, safe and feasible as a bridge to surgery for malignant colonic obstruction.

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“…This metaanalysis highlighted that SEMS as BTS does not confer an advantage in short-term mortality [12] in contrast with previous meta-analyses [33À36]. The findings by Arezzo et al were recently confirmed by another 2 meta-analyses, respectively by Yang et al [37] and by Boland et al [38]. Colostomy is often maintained for life, due to comorbidities or willingness to avoid re-operation in elderly patients, carrying a significant deterioration in the quality of life.…”

Section: Comparison With Es: Short-term Outcomesmentioning

confidence: 81%

Colorectal stenting for palliation and bridge to surgery of obstructing cancer

Frazzoni

Fabbri

Bazzoli

et al. 2020

Techniques and Innovations in Gastrointestinal Endoscopy

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Outcomes following colonic stenting for malignant left-sided bowel obstruction: a systematic review of randomised controlled trials

Cited by 24 publications

References 34 publications

Current Status of the Self-Expandable Metal Stent as a Bridge to Surgery Versus Emergency Surgery in Colorectal Cancer: Results from an Updated Systematic Review and Meta-Analysis of the Literature

Current Status of the Self-Expandable Metal Stent as a Bridge to Surgery Versus Emergency Surgery in Colorectal Cancer: Results from an Updated Systematic Review and Meta-Analysis of the Literature

Fluoroscopic Stenting as a Bridge to Surgery versus Emergency Management for Malignant Obstruction of the Colon

Colorectal stenting for palliation and bridge to surgery of obstructing cancer

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