Transanal decompression tube is superior to self‐expandable metallic colonic stent for malignant colorectal obstruction: a retrospective study

Zhang, Shuai; Guang, Liu; Wu, Guanghai; Zhao, Yan; Xu, Jing

doi:10.1111/ans.17274

Cited by 4 publications

(4 citation statements)

References 33 publications

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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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“…Some studies have shown that stent compression of tumor tissue can lead to extracellular tumor cell sedimentation, and pressure can induce the production of hyaluronic acid, an adhesive molecule that promotes the progression of malignant tumors. [ 37 ] Therefore, in order to reduce the risk of tumor spread caused by mechanical pressure and tissue erosion from the stent itself, the placement time of the stent should be minimized on the premise of improving intestinal symptoms. However, some studies have shown that the insertion of stents can lead to the spread of cancer cells into the blood, but these shed cancer cells may not be tumor stem cells and have a low malignant potential.…”

Section: Discussionmentioning

confidence: 99%

Colonic stent as a bridge to surgery versus emergency rection for malignant left-sided colorectal obstruction: A systematic review and meta-analysis of randomized controlled trials

Shang,

Han,

Zeng

et al. 2023

Medicine

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Introduction: The role of self-expanding metal stent (SEMS) implantation as a bridge to surgery in malignant left-sided colorectal obstruction (MLCO) remains controversial. Objective: To evaluate the safety of SEMS implantation versus emergency surgery (ER) in the treatment of MLCO. Methods: Four major literature databases (Cochrane Library, Embase, PubMed, and Web of Science) were searched to collect articles published before April 20, 2023. After determining random or fixed-effect models based on heterogeneity tests, odds ratios (RR) or standardized mean differences (SMD) with their respective 95% confidence intervals (CI) were calculated. Results: Nineteen randomized controlled studies were included. The main outcomes included overall tumor recurrence rate, 30-day mortality rate, and overall incidence of complications. Secondary outcomes included mortality-related indicators, tumor recurrence-related indicators, surgery-related indicators, and other relevant indicators. The study found that there was no significant difference in the 30-day mortality rate between the SEMS group and the er group. However, the SEMS group had a lower overall incidence of complications (RR = 0.787, P = .004), lower incision infection rate (RR = 0.472, P = .003), shorter operation time (SMD = −0.591, P = .000), lower intraoperative blood loss (SMD = −1.046, P = .000), lower intraoperative transfusion rate (RR = 0.624, P = .021), lower permanent stoma rate (RR = 0.499, P = .000), lower overall stoma rate (RR = 0.520,P = .000), shorter hospital stay (SMD = −0.643, P = .014), and more lymph node dissections during surgery (SMD = 0.222, 95% CI: 0.021–0.423, P = .031), as well as a higher primary anastomosis rate (RR = 0.472, 95% CI: 0.286–0.7 77, P = .003), among other advantages. However, the SEMS group had a higher overall tumor recurrence rate (RR = 1.339, P = .048). Conclusion: SEMS has significant advantages over er in relieving clinical symptoms and facilitating postoperative recovery in MLCO, but does not reduce the tumor recurrence rate. Neoadjuvant chemotherapy combined with SEMS may provide a new approach to the treatment of MLCO.

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“…Other authors have also reported negative factors for SEMS placement from a pathological viewpoint. Zhang et al [ 51 ] analyzed the histopathological findings of specimens resected after SEMS or TDT for OLCC. The authors reported that vascular invasions, wound abscesses, and ulcer formation was more frequently observed in the SEMS group than in the TDT group.…”

Section: Short-term and Long-term Outcomesmentioning

confidence: 99%

Oncologic impact of colonic stents for obstructive left-sided colon cancer

Suzuki¹,

Tsujinaka²,

Sato³

et al. 2023

World J Clin Oncol

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Colonic stenting has had a significant positive impact on the management of obstructive left-sided colon cancer (OLCC) in terms of both palliative treatment and bridge-to-surgery (BTS). Notably, many studies have convincingly demonstrated the effectiveness of stenting as a BTS, resulting in improvements in short-term outcomes and quality of life, safety, and efficacy in subsequent curative surgery, and increased cost-effectiveness, whereas the safety of chemotherapy after stenting and the long-term outcomes of stenting as a BTS are controversial. Several studies have suggested an increased risk of perforation in patients receiving bevacizumab chemotherapy after colonic stenting. In addition, several pathological analyses have suggested a negative oncological impact of colonic stenting. In contrast, many recent studies have demonstrated that colonic stenting for OLCC does not negatively impact the safety of chemotherapy or long-term oncological outcomes. The updated version of the European Society of Gastrointestinal Endoscopy guidelines released in 2020 included colonic stenting as a BTS for OLCC as a recommended treatment. It should be noted that the experience of endoscopists is involved in determining technical and clinical success rates and possibly oncological outcomes. This review discusses the positive and negative impacts of colonic stenting on OLCC treatment, particularly in terms of oncology.

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Transanal decompression tube is superior to self‐expandable metallic colonic stent for malignant colorectal obstruction: a retrospective study

Cited by 4 publications

References 33 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

Colonic stent as a bridge to surgery versus emergency rection for malignant left-sided colorectal obstruction: A systematic review and meta-analysis of randomized controlled trials

Oncologic impact of colonic stents for obstructive left-sided colon cancer

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