Outcomes of Patients with Left-Sided Obstructive Colorectal Cancer: Comparison between Self-Expandable Metallic Stent and Other Treatment Methods

Kondo, Akihiro; Kumamoto, Kensuke; Kobara, Hideki; Nagahara, Teruya; Wato, Masahiro; Shibatoge, Mitsushige; Minato, Takuya; Masaki, Tsutomu; Okano, Keiichi

doi:10.1159/000524645

Cited by 3 publications

(2 citation statements)

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“…Twenty studies evaluated perioperative short-term outcomes [ 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 ]. Nine studies evaluated 3-year OS [ 18 19 20 21 22 26 30 31 32 ], and 12 studies evaluated 3-year RFS [ 10 11 12 13 14 15 17 18 21 22 23 24 ]. All studies determining OS and RFS evaluated patients with stage II or III colorectal cancers.…”

Section: Resultsmentioning

confidence: 99%

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Short-term and long-term oncologic outcomes of self-expandable metallic stent compared with tube decompression for obstructive colorectal cancer: a systematic review and meta-analysis

Ha,

Lee

2024

Ann Surg Treat Res

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Purpose Patients with obstructive colorectal cancer managed by emergency surgery show high morbidity, mortality, and stoma formation rates. Decompression modalities, including the self-expandable metallic stent (SEMS) and tube drainage (TD), have been used to improve surgical outcomes. However, there have been limited studies comparing the 2 modalities. We performed a meta-analysis on short- and long-term outcomes between SEMS and TD. Methods PubMed, EMBASE, Cochrane Library, and Google Scholar were searched. Data were pooled, and the overall effect size was calculated using random effect models. Outcome measures were perioperative short-term and 3-year survival outcomes. Results We included 20 nonrandomized studies that examined 2,047 patients in the meta-analysis. The meta-analysis showed SEMS had better short-term outcomes in clinical success rate, decompression-related complications, laparoscopic surgery rate, stoma formation rate, and postoperative complication rate with a relative risk (RR) of 0.36 (95% confidence interval [CI], 0.24–0.54; I 2 = 20%), 0.32 (95% CI, 0.20–0.50; I 2 = 0%), 0.47 (95% CI, 0.34–0.66; I 2 = 87%), 0.34 (95% CI, 0.24–0.49; I 2 = 52%), and 0.70 (95% CI, 0.54–0.89, I 2 = 28%), respectively. However, there was no significant difference between the 2 groups in 3-year overall survival (RR, 0.99; 95% CI, 0.77–1.27; I 2 = 0%). Conclusion Although the long-term oncologic impact of SEMS is still unclear compared with TD, the results of this meta-analysis may suggest that SEMS insertion can be performed more successfully and safely and may have benefits for short-term perioperative outcomes compared with TD. Further studies are warranted to provide more definitive survival results.

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Section: Resultsmentioning

confidence: 99%

“…All studies determining OS and RFS evaluated patients with stage II or III colorectal cancers. Eleven studies evaluated patients with left-sided obstructive colorectal cancers [ 20 22 23 24 25 27 28 32 33 35 36 ]. One study evaluated patients with right-sided obstructive colorectal cancers [ 31 ].…”

Section: Resultsmentioning

confidence: 99%

Short-term and long-term oncologic outcomes of self-expandable metallic stent compared with tube decompression for obstructive colorectal cancer: a systematic review and meta-analysis

Ha,

Lee

2024

Ann Surg Treat Res

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Self-expanding metal stents versus decompression tubes as a bridge to surgery for patients with obstruction caused by colorectal cancer: a systematic review and meta-analysis

Ma,

Zhang,

Luo

et al. 2023

World J Emerg Surg

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Background Using self-expanding metal stents (SEMS) and decompression tubes (DT) as a bridge-to-surgery (BTS) treatment may avoid emergency operations for patients with colorectal cancer-caused obstructions. This study aimed to evaluate the efficacy and safety of the two approaches. Methods We systematically retrieved literature from January 1, 2000, to May 30, 2023, from the PubMed, Embase, Web of Science, SinoMed, Wanfang Data, Chinese National Knowledge Infrastructure, and Cochrane Central Register of Clinical Trials databases. Randomized controlled trials (RCTs) or cohort studies of SEMS versus DT as BTS in colorectal cancer obstruction were selected. Risks of bias were assessed for RCTs and cohort studies using the Cochrane Risk of Bias tool version 2 and Risk of Bias in Nonrandomized Studies of Interventions. Certainty of evidence was determined using the Graded Recommendation Assessment. Odds ratio (OR), mean difference (MD), and 95% confidence interval (95% CI) were used to analyze measurement data. Results We included eight RCTs and eighteen cohort studies involving 2,061 patients (SEMS, 1,044; DT, 1,017). Pooled RCT and cohort data indicated the SEMS group had a significantly higher clinical success rate than the DT group (OR = 1.99, 95% CI 1.04, 3.81, P = 0.04), but no significant difference regarding technical success (OR = 1.29, 95% CI 0.56, 2.96, P = 0.55). SEMS had a shorter postoperative length of hospital stays (MD = − 4.47, 95% CI − 6.26, − 2.69, P < 0.00001), a lower rates of operation-related abdominal pain (OR = 0.16, 95% CI 0.05, 0.50, P = 0.002), intraoperative bleeding (MD = − 37.67, 95% CI − 62.73, − 12.60, P = 0.003), stoma creation (OR = 0.41, 95% CI 0.23, 0.73, P = 0.002) and long-term tumor recurrence rate than DT (OR = 0.47, 95% CI 0.22, 0.99, P = 0.05). Conclusion SEMS and DT are both safe as BTS to avoid emergency surgery for patients with colorectal cancer obstruction. SEMS is preferable because of higher clinical success rates, lower rates of operation-related abdominal pain, intraoperative bleeding, stoma creation, and long-term tumor recurrence, as well as a shorter postoperative length of hospital stays. Trial registrationCRD42022365951.

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Outcomes of the combined application of ultrathin endoscope and guidewire replacement for self-expandable metal stent placement in colorectal carcinoma with intestinal obstruction: A retrospective analysis

Shu

Chen

et al. 2023

Preprint

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Background: Self-expandable metal stent (SEMS) placement with an emergency colonoscope has been gradually applied to treat colorectal carcinoma with intestinal obstruction (CCIO). We proposed a new technique based on current SEMS placement with the combined application of ultrathin endoscope and guidewire replacement to solve previous technical difficulties. This study evaluated its feasibility, efficacy, and safety for SEMS placement in CCIO. Methods: We retrospectively analyzed data of 31 CCIO patients, who received the novel SEMS placement technique at Wuhan No.1 Hospital between June 2019 and October 2022. Technical and clinical success rates, adverse events, prognosis, and follow-up were evaluated. Inter-group differences between bridge to surgery (BTS) and palliative treatment (PT) groups and clinical feasibility of this technique were analyzed. Results: Overall technical and clinical success rates were 100% (31/31) and 96.8% (30/31), respectively, without adverse events. There was no significant difference in procedure time and technical/clinical success rates among three attending physicians(p>0.05). Fourteen BTS patients (14/31, 45.2%) underwent SEMS with a post-placement confined operation, which had a 100% success rate (14/14) and no ostomy. Median follow-up time was 67.5 days, and four patients (4/14, 28.6%) had postoperative adverse events of inflammatory anastomotic changes. Seventeen PT patients had a median follow-up time of 30 days, without adverse events. Two patients (2/17, 11.8%) underwent follow-up colonoscopywith no post-placement stent migration/obstruction. Conclusions: The combined application of ultrathin endoscope with guidewire replacement for SEMS placement to treat CCIO could avoid X-ray-induced medical radiation damage and reduce cross-infection risk, making it clinically safe, effective, and promotion suitable.

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Outcomes of Patients with Left-Sided Obstructive Colorectal Cancer: Comparison between Self-Expandable Metallic Stent and Other Treatment Methods

Cited by 3 publications

References 24 publications

Short-term and long-term oncologic outcomes of self-expandable metallic stent compared with tube decompression for obstructive colorectal cancer: a systematic review and meta-analysis

Short-term and long-term oncologic outcomes of self-expandable metallic stent compared with tube decompression for obstructive colorectal cancer: a systematic review and meta-analysis

Self-expanding metal stents versus decompression tubes as a bridge to surgery for patients with obstruction caused by colorectal cancer: a systematic review and meta-analysis

Outcomes of the combined application of ultrathin endoscope and guidewire replacement for self-expandable metal stent placement in colorectal carcinoma with intestinal obstruction: A retrospective analysis

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