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

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Bing Li ◽  
Shi-Lun Cai ◽  
Zhen-Tao Lv ◽  
Ping-Hong Zhou ◽  
Li-Qing Yao ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Emergency Surgery ◽  
Elective Surgery ◽  
Primary Tumour ◽  
Stage Iv ◽  
Sems Placement ◽  
Short Term ◽  
Synchronous Liver Metastases ◽  
Sems Group ◽  
Significant Difference

Abstract Background The use of a self-expandable metallic stent (SEMS) as a bridge to surgery has increased for patients with obstructing colorectal cancer. However, relatively few reports have compared SEMS as a bridge to elective surgery for acute malignant obstruction of the right-sided colon (MORC) vs. emergency surgery (ES). This study aimed to evaluate the benefits of elective surgery after SEMS placement vs. ES for patients (including stage IV cases) with acute MORC. 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. Also, there was no significant difference in PFS and OS rates between patients with stage II and III colon cancer. After colectomy for synchronous liver metastases among stage IV patients, 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.

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

2020 ◽  
Author(s):  
Bing Li ◽  
Shi-Lun Cai ◽  
Zhen-Tao Lv ◽  
Ping-Hong Zhou ◽  
Li-Qing Yao ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Emergency Surgery ◽  
Elective Surgery ◽  
Primary Tumour ◽  
Stage Iv ◽  
Sems Placement ◽  
Short Term ◽  
Synchronous Liver Metastases ◽  
Sems Group ◽  
Significant Difference

Abstract Background: The use of a self-expandable metallic stent (SEMS) as a bridge to surgery has increased for patients with obstructing colorectal cancer. However, relatively few reports have compared SEMS as a bridge to elective surgery for acute malignant obstruction of the right-sided colon (MORC) vs. emergency surgery (ES). This study aimed to evaluate the benefits of elective surgery after SEMS placement vs. ES for patients (including stage IV cases) with acute MORC.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. Also, there was no significant difference in PFS and OS rates between patients with stage II and III colon cancer. After colectomy for synchronous liver metastases among stage IV patients, 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.

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

2020 ◽  
Author(s):  
Bing Li ◽  
Shi-Lun Cai ◽  
Zhen-Tao Lv ◽  
Ping-Hong Zhou ◽  
Li-Qing Yao ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Emergency Surgery ◽  
Elective Surgery ◽  
Primary Tumour ◽  
Stage Iv ◽  
Sems Placement ◽  
Short Term ◽  
Synchronous Liver Metastases ◽  
Sems Group ◽  
Significant Difference

Abstract Background: The use of a self-expandable metallic stent (SEMS) as a bridge to surgery has increased for patients with obstructing colorectal cancer. However, relatively few reports have compared SEMS as a bridge to elective surgery for acute malignant obstruction of the right-sided colon (MORC) vs. emergency surgery (ES). This study aimed to evaluate the benefits of elective surgery after SEMS placement vs. ES for patients (including stage IV cases) with acute MORC.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. Also, there was no significant difference in PFS and OS rates between patients with stage II and III colon cancer. After colectomy for synchronous liver metastases among stage IV patients, 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.

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

2020 ◽  
Author(s):  
Bing Li ◽  
Shi-Lun Cai ◽  
Zhen-Tao Lv ◽  
Ping-Hong Zhou ◽  
Li-Qing Yao ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Emergency Surgery ◽  
Elective Surgery ◽  
Primary Tumour ◽  
Sems Placement ◽  
Short Term ◽  
Colorectal Obstruction ◽  
Synchronous Liver Metastases ◽  
Sems Group ◽  
Significant Difference

Abstract 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.

Short-Term and Long-Term Outcomes of Self-Expanding Metallic Stent Versus Decompressing Stoma as the Bridge of Elective Surgery for Left-Sided Obstructive Colon Cancer A Meta-Analysis

2021 ◽  
Vol 7 (5) ◽  
pp. 1853-1864
Author(s):  
Jin Jing ◽  
Wei Xu ◽  
Haiming Xu ◽  
ZhengHong Yu ◽  
Mengyun zhou ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Elective Surgery ◽  
Meta Analysis ◽  
Complete Analysis ◽  
Cochrane Library ◽  
Metallic Stent ◽  
Sems Placement ◽  
Short Term ◽  
Significant Difference

Background: Compared to emergency resection, elective surgery is a better choice for the people suffering from left-sided obstructive colon cancer (LOSCC). Both are considered as self-expanding decompressing stoma (DS) construction and metallic stent (SEMS) placement are accessible bridges for elective surgery (BTS). We aimed to perform meta-analysis of LOSCC databases to comparethe pros and cons of the two options. Method: LOSCC patients with curative intent were searched in medical databases, including PUBMED, MEDLINE, and the Cochrane Library. Results were expressed as risk ratios. The meta-analysis was performed by Revman5.3. Result: Three comparative studies were selected, including 847 LOSCC patients. The complete analysis showed that there is no statistically significant difference regarding primary anastomosis (0R=1.15, 95% CI 0.30-4.41, P=0.84), There was no significant difference in 90-day recurrence rate post resection (OR=0.90, 95% CI 0.68-1.20, P=0.47), and major complication (OR=1.86, 95% CI 0.98-3.54, P=0.06) between SEMS and DS group. In addition, the permanent stomas (OR=0.82; 95% CI 0.60-1.13, P=0.23), overall recurrence (OR=0.82, 95% CI 0.48-1.40, P=0.46), and overall survival of 3-years (OR=1.24, 95% CI 0.69-2.25, P=0.48) showed no statistical difference between SEMS and DS group. Conclusion: The after-effects of both short-term and long-term in patients who were treated by SEMS or DS as BTS for LSOCC were not statistically significant. Considering of the even complicated surgical interventions, prolonged hospital stays, and worse body image of DS construction, SEMS placement seems to be the preferred option in treating LSOCC patients.

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

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yang Hu ◽  
Jiajun Fan ◽  
Yifan Xv ◽  
Yingjie Hu ◽  
Yuan Ding ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Emergency Surgery ◽  
Meta Analysis ◽  
Metal Stents ◽  
Bridge To Surgery ◽  
Sems Group ◽  
Obstructive Colorectal Cancer ◽  
Significant Difference ◽  
Self Expanding Metal Stents

Abstract 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 SEMS 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 of perineural 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, their adverse effects cannot be ignored. The use of SEMS as the preferred treatment for patients with resectable obstructive colorectal cancer remains to be carefully weighed, especially when patients are young or the surgical risk is not very high.

Locoregional surgery of the primary tumor in stage IV breast cancer patients.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 566-566
Author(s):  
Ying Wang ◽  
Yunfang Yu ◽  
Kai Chen ◽  
Tuping Fu ◽  
Herui Yao
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Primary Tumor ◽  
Primary Tumour ◽  
Stage Iv ◽  
Current Evidence ◽  
Breast Cancer Patients ◽  
Stage Iv Breast Cancer ◽  
Significant Difference ◽  
Quality Evidence

566 Background: Existing guidelines lack clear recommendations for the role of locoregional treatment for the primary tumor in women with stage IV breast cancer. We aimed to compare the effectiveness of locoregional surgery with no surgery of the primary tumour in stage IV breast cancer patients. Methods: Eligible studies were randomized clinical trials (RCTs) that investigated the effect of locoregional surgery versus no surgery of the primary tumour in stage IV breast cancer patients. The primary outcome was overall survival (OS), measured as hazard ratios (HRs). Secondly outcomes included 2-year and 3-year OS, expressed as odds ratios (ORs). Meta-analyses and trial sequential analysis (TSA) were conducted. Quality was evaluated using the GRADE. Results: Data were included from four RCTs involving 767 participants, including 377 who underwent locoregional surgery and 390 who with no surgery. The median follow-up was 28.6 months (95% confidence interval (CI) 24.1 to 33.9). In a meta-analysis of these trials, the low-quality evidence indicated that locoregional surgery versus no surgery did not significantly affect OS (HR = 0.87, 95% CI 0.59 to 1.29, P = 0.490), 2-year OS (OR = 1.23, 0.66 to 2.30, P = 0.510), or 3-year OS (OR = 1.08, 0.94 to 1.25, P = 0.263). TSA showed that more trials were needed before reliable conclusions could be drawn regarding in both 2-year and 3-year OS. Across the subgroup analysis of OS, we found the moderate-quality evidence that locoregional surgery followed by chemotherapy versus chemotherapy alone resulted into a significantly improved survival (HR = 0.65, 95% CI 0.49–0.87, P = 0.004); but no statistically significant difference was identified in term of response to chemotherapy with or without locoregional surgery (HR = 1.06, 95% CI 0.83–1.36, P = 0.632). Conclusions: The current evidence suggests that locoregional surgery followed by chemotherapy, compared with chemotherapy alone, was beneficial for prolonging OS in patients with stage IV breast cancer, but surgery did not impact OS among patients who have responded to chemotherapy.

scholarly journals Short-Term Outcomes of Simultaneous Laparoscopic Colectomy and Hepatectomy for Primary Colorectal Cancer With Synchronous Liver Metastases

2014 ◽  
Vol 99 (4) ◽  
pp. 338-343 ◽  
Author(s):  
Akira Inoue ◽  
Mamoru Uemura ◽  
Hirofumi Yamamoto ◽  
Masayuki Hiraki ◽  
Atsushi Naito ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Liver Metastases ◽  
Laparoscopic Colectomy ◽  
Postoperative Mortality ◽  
Laparoscopic Approach ◽  
Resection Margins ◽  
Primary Colorectal Cancer ◽  
Short Term ◽  
Synchronous Liver Metastases ◽  
Estimated Blood Loss

Abstract Although simultaneous resection of primary colorectal cancer and synchronous liver metastases is reported to be safe and effective, the feasibility of a laparoscopic approach remains controversial. This study evaluated the safety, feasibility, and short-term outcomes of simultaneous laparoscopic surgery for primary colorectal cancer with synchronous liver metastases. From September 2008 to December 2013, 10 patients underwent simultaneous laparoscopic resection of primary colorectal cancer and synchronous liver metastases with curative intent at our institute. The median operative time was 452 minutes, and the median estimated blood loss was 245 mL. Median times to discharge from the hospital and adjuvant chemotherapy were 13.5 and 44 postoperative days, respectively. Negative resection margins were achieved in all cases, with no postoperative mortality or major morbidity. Simultaneous laparoscopic colectomy and hepatectomy for primary colorectal cancer with synchronous liver metastases appears feasible with low morbidity and favorable outcomes.

scholarly journals Nationwide Outcomes of Simultaneous Resection of Primary Colorectal Cancer and Synchronous Liver Metastases

2021 ◽  
Author(s):  
Kara D Bowers ◽  
Allison Rice ◽  
Joshua Parreco ◽  
Alvaro Castillo
Keyword(s):  
Colorectal Cancer ◽  
Liver Metastases ◽  
Colon Resection ◽  
Primary Colorectal Cancer ◽  
Total Cost ◽  
Synchronous Liver Metastases ◽  
Simultaneous Resection ◽  
Improved Outcomes ◽  
Significant Difference ◽  
The Us

Abstract Background Of the few studies comparing simultaneous versus staged resection of primary colorectal cancer and synchronous liver metastases, most are limited to resections performed at the same facility. This study was performed to compare outcomes of simultaneous versus staged resection in these patients, including resections performed at a different center. Methods The Nationwide Readmissions Database was queried for all patients undergoing colorectal cancer and metastatic liver resections in the US from 2010 to 2014. Patients undergoing simultaneous resections were compared to patients who underwent liver and colon resections on separate admissions, both liver first and colon first. The outcomes of interest were in-hospital mortality, complications, and total cost. Results During the study period, there were 6,219 patients undergoing resection of primary colorectal cancer and synchronous liver metastases. Separate admission resection was performed at a different hospital in 45.8%. Compared to simultaneous resection, there was a reduced risk for mortality in patients undergoing colon first (OR 0.28, p<0.01) and there was no significant difference in performing liver resection first (OR 0.30, p=0.05). Simultaneous resection was associated with a decreased mean total cost of admissions compared to separate admission resection ($37,278 ±​$34,353 versus $47,985 ​±$​ 28,342, p<0.01). Conclusions Nearly half of separate admission resections of primary colorectal cancer and liver metastases are performed at different hospitals and likely missed by single-center studies. Undergoing colon resection first on a separate admission is costlier, yet patients have more favorable outcomes. Further studies are needed to reveal the underlying factors responsible for these improved outcomes.

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

2020 ◽  
Author(s):  
Yang Hu ◽  
Jiajun Fan ◽  
Yifan Xv ◽  
Yingjie Hu ◽  
Yuan Ding ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Emergency Surgery ◽  
Meta Analysis ◽  
Metal Stents ◽  
Bridge To Surgery ◽  
Sems Group ◽  
Obstructive Colorectal Cancer ◽  
Significant Difference ◽  
Self Expanding Metal Stents

Abstract 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 SEMS 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 of perineural 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, their adverse effects cannot be ignored. The use of SEMS as the preferred treatment for patients with resectable obstructive colorectal cancer remains to be carefully weighed, especially when patients are young or the surgical risk is not very high.

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