scholarly journals Comparison of the prognosis of four different treatment strategies for acute left malignant colonic obstruction: A systematic review and network meta-analysis

2020 ◽  
Author(s):  
Ling Tan ◽  
Zi-Lin Liu ◽  
Meng-Ni Ran ◽  
Ling-Han Tang ◽  
Yan-Jun Pu ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Colonic Obstruction ◽  
Treatment Strategies ◽  
Long Term Results ◽  
Bridge To Surgery ◽  
Term Survival ◽  
Malignant Colonic Obstruction ◽  
Significant Difference ◽  
Better Than

Abstract Background There is controversy regarding the efficacy of different treatment strategies for acute left malignant colonic obstruction. This study investigated the prognosis of several treatment strategies for acute left malignant colonic obstruction. Methods A systematic literature review and network meta-analysis were performed. Results The network meta-analysis involved 48 articles, including 8 (Randomized controlled trials) RCTs and 40 non-RCTs. Short-term results: Compared with emergency surgery (ES) strategies, colonic stent-bridge to surgery (CS-BTS) and transanal colorectal tube-bridge to surgery (TCT-BTS) strategies can significantly increase the primary anastomosis rate, CS-BTS and decompressing stoma-bridge to surgery (DS-BTS) strategies can significantly reduce mortality, and CS-BTS strategies can significantly reduce the permanent stoma rate. The hospital stay of DS-BTS is significantly longer than that of other strategies. There was no significant difference in the anastomotic leakage levels of several treatment strategies. Long-term results: The 5-year overall survival (OS) and disease-free survival (DFS) of the CS-BTS strategy and the DS-BTS strategy were significantly better than those of the ES strategy, and the 5-year OS of the DS-BTS strategy was significantly better than that of CS-BTS. The long-term survival of TCT-BTS was not significantly different from those of CS-BTS and ES. Conclusion Different preoperative decompression strategies may improve the prognosis of patients with acute left malignant colon obstruction. Comprehensive literature research, we found that timely and effective relief of intestinal obstruction would bring a better prognosis. Therefore, CS-BTS, DS-BTS and TCT-BTS are better than ES. Compared with CS-BTS and DS-BTS, CS-BTS has the risk of re-obstruction and intestinal perforation, and the long-term prognosis is slightly worse than that of DS-BTS. Without considering the length of stay and cost, DS-BTS strategy is the best choice.

scholarly journals Comparison of the prognosis of four different treatment strategies for acute left malignant colonic obstruction: a systematic review and network meta-analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ling Tan ◽  
Zi-lin Liu ◽  
Meng-ni Ran ◽  
Ling-han Tang ◽  
Yan-jun Pu ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Colonic Obstruction ◽  
Treatment Strategies ◽  
Disease Free Survival ◽  
Bridge To Surgery ◽  
Free Survival ◽  
Malignant Colonic Obstruction ◽  
Secondary Outcomes ◽  
Disease Free ◽  
Better Than

Abstract Background There is controversy regarding the efficacy of different treatment strategies for acute left malignant colonic obstruction. This study investigated the 5-year overall survival (OS) and disease-free survival (DFS) of several treatment strategies for acute left malignant colonic obstruction. Methods We searched for articles published in PubMed, Embase (Ovid), MEDLINE (Ovid), Web of Science, and Cochrane Library between January 1, 2000, and July 1, 2020. We screened out the literature comparing different treatment strategies. Evaluate the primary and secondary outcomes of different treatment strategies. The network meta-analysis summarizes the hazard ratio, odds ratio, mean difference, and its 95% confidence interval. Results The network meta-analysis involved 48 articles, including 8 (randomized controlled trials) RCTs and 40 non-RCTs. Primary outcomes: the 5-year overall survival (OS) and disease-free survival (DFS) of the CS-BTS strategy and the DS-BTS strategy were significantly better than those of the ES strategy, and the 5-year OS of the DS-BTS strategy was significantly better than that of CS-BTS. The long-term survival of TCT-BTS was not significantly different from those of CS-BTS and ES. Secondary outcomes: compared with emergency resection (ER) strategies, colonic stent-bridge to surgery (CS-BTS) and transanal colorectal tube-bridge to surgery (TCT-BTS) strategies can significantly increase the primary anastomosis rate, CS-BTS and decompressing stoma-bridge to surgery (DS-BTS) strategies can significantly reduce mortality, and CS-BTS strategies can significantly reduce the permanent stoma rate. The hospital stay of DS-BTS is significantly longer than that of other strategies. There was no significant difference in the anastomotic leakage levels of several treatment strategies. Conclusion Comprehensive literature research, we find that CS-BTS and DS-BTS strategies can bring better 5-year OS and DFS than ER. DS-BTS strategies have a better 5-year OS than CS-BTS strategies. Without considering the hospital stays, DS-BTS strategy is the best choice.

scholarly journals Results of surgical treatment of carcinoma of papilla of Vater

Medicina ◽  
2006 ◽  
Vol 43 (6) ◽  
pp. 455 ◽  
Author(s):  
Giedrius Barauskas ◽  
Antanas Gulbinas ◽  
Juozas Pundzius
Keyword(s):  
Postoperative Morbidity ◽  
Postoperative Mortality ◽  
Long Term Results ◽  
Papilla Of Vater ◽  
Term Survival ◽  
Retrospective Design ◽  
Significant Difference ◽  
Survival Pattern ◽  
Better Than

Adenocarcinoma is the most common malignant tumor of the ampulla, but in general, it is still rare. Therefore, these tumors are difficult to study, and most reports are of retrospective design. To evaluate immediate postoperative and long-term results, we have collected data prospectively in a specially created database on 21 consecutive patients with adenocarcinoma of the papilla of Vater, operated on at the Department of Surgery, Kaunas University of Medicine Hospital. All patients have undergone classical or pylorus-preserving pancreatoduodenectomy. Postoperative mortality was 4.8% and overall morbidity – 28.6%. Pancreas-associated morbidity was 14.3% in the series. Actuarial 3-year survival among our patients was 89%. Stage I–II patients with T1–T2 and/or N negative tumors had significantly better 3-year survival when compared with stage III–IV patients, T3–T4 and/or N positive tumors. Patients with highly or moderately differentiated tumors (G1, G2) survived better than patients with poor cell differentiation (G3), though significant difference was not achieved. Results are satisfactory in terms of overall postoperative morbidity and mortality. Long-term survival pattern concerning T, N, and G status corresponds with other reports in literature, while the 3-year survival results are promising and speaks in favor of our surgical strategy.

Long-term oncologic safety of self-expandable metal stent as a bridge to surgery for malignant colorectal obstruction: Our experience.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 153-153
Author(s):  
Se Hyun Jang ◽  
Bora Keum ◽  
Sanghyun Kim ◽  
Kang Won Lee ◽  
Han Jo Jeon ◽  
...  
Keyword(s):  
Colonic Obstruction ◽  
Bridge To Surgery ◽  
Metal Stent ◽  
Term Survival ◽  
Colorectal Obstruction ◽  
Long Term Survival ◽  
Sems Group ◽  
Surgery Group ◽  
Significant Difference

153 Background: About 10-25% patients of colorectal cancer suffer from acute colonic obstruction. Traditional management of acute malignant bowel obstruction has focused on emergency resection but showed high mortality and morbidity rates. Recently, placement of a self-expanding metal stent(SEMS) was widely used and SEMS seems to be as a safe and effective “bridge to surgery” and to offer good palliation. But there is concern about long-term survival after the use of SEMS. Theoretically, tumor cell seeding can occur due to mechanical force during the stent insertion. To identify this theoretical validity, we surveyed long-term survival of malignant colonic obstruction using SEMS placement. Methods: This retrospective study included 303 patients who presented in Korea University Anam Hospital between 2006 and 2014 with obstructing CRC, and underwent surgical resection. Patients were devided into two group: the “SEMS” group included 148 patients who underwent endoscopic stent as a bridge to surgery, and the surgery group included 155 patients who underwent emergency or elective surgery without stenting. In addition, candidates for curative resection were identified (98 patients in “SEMS” group vs 101 patients in “surgery” group). The clinicopathologic characteristics, overall survival(OS), and recurrence-free survival (RFS) were compared between the two groups. Results: There was no significant difference in demographics, tumor stage between the two group. The median follow-up times were 48.5 months (IQR, 19.1-73.1 months) for the SEMS group and 39.4 months (IQR, 15.1-39.4 months) for the surgery group. There was no significant difference in 5-year OS rate between two groups (59.6% vs 56.8%; p = 0.3). The 5-year RFS rate did not significantly differ between two groups (71.0% vs. 61.3%; p = 0.221). The long-term oncologic safety did not significantly differ between two groups in either the 5-year OS rate (79.5% vs 74.5%; P= 0.6). or the 5-year RFS rate (95.8% vs 95.8%; P = 0.3). Conclusions: SEMS as bridge to surgery in obstructive CRC did not worsen the long-term oncologic outcomes compared to those of the primary surgery.

Su1728 LONG-TERM SURVIVAL ANALYSIS AFTER ENDOSCOPIC STENTING AS A BRIDGE TO SURGERY FOR MALIGNANT COLONIC OBSTRUCTION: COMPARISON WITH EMERGENCY SURGERY

2019 ◽  
Vol 89 (6) ◽  
pp. AB397-AB398
Author(s):  
Rodrigo Corsato Scomparin ◽  
Bruno da Costa Martins ◽  
Carlos F. Marques ◽  
Caio Sergio R. Nahas ◽  
Fabio S. Kawaguti ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Emergency Surgery ◽  
Colonic Obstruction ◽  
Endoscopic Stenting ◽  
Bridge To Surgery ◽  
Term Survival ◽  
Long Term Survival ◽  
Malignant Colonic Obstruction

Post-Discharge Outcomes After Pancreatic Necrosectomy: A Single Institution Experience Following Endoscopic vs Open Debridement

2021 ◽  
pp. 000313482110385
Author(s):  
Manuel Martinez ◽  
Steven Medeiros ◽  
James Dove ◽  
Mohsen Shabahang
Keyword(s):  
Necrotizing Pancreatitis ◽  
Long Term Results ◽  
Source Control ◽  
Tertiary Referral Hospital ◽  
Term Survival ◽  
Pancreatic Necrosectomy ◽  
Medical Comorbidities ◽  
Number Of Patients ◽  
Significant Difference

Background Pancreatic necrosectomy outcomes have been studied extensively; however, long-term results of these procedures have not been well characterized. Our study aimed to assess the outcomes at and after discharge for patients following necrosectomy. Methods Data from patients undergoing pancreatic necrosectomy at a single tertiary referral hospital from January 1, 2007, to June 1, 2019 were retrospectively analyzed. Patients were stratified into an open pancreatic necrosectomy (OPN) and an endoscopic pancreatic necrosectomy (EPN) group. Results Cohorts were composed of an OPN (n = 30) and EPN (n = 31) groups with a mean follow-up of 22 and 13.5 months, respectively. There was no statistically significant difference in the demographics or etiology of disease; however, the presence of severe sepsis and elevated BISAP scores was significantly higher in the OPN group (40% vs 13% p = .016, 37% vs 10% p = .012, respectively). There was no significant difference in discharge parameters or disposition other than a higher need for wound care in the OPN group (14% vs 0% p =< .0001). No significant difference in the number of patients who returned to baseline, 12-month ED visits, 12-month readmissions, medical comorbidities, or long-term survival was noted. Conclusions Previous studies have demonstrated that OPN patients have a higher severity of disease and higher inpatient mortality; however, this does not hold true once the acute phase of the illness has passed. Long-term medical comorbidities and survival of patients with necrotizing pancreatitis who endure the primary insult do not differ in long term, regardless of the debridement modality performed for source control.

Long Term Survival after Colonic Stenting and Restenting for Malignant Colonic Obstruction

2010 ◽  
Vol 76 (4) ◽  
pp. 457-459
Author(s):  
Khristian A. Noto ◽  
Christopher Almario ◽  
Pinckney J. Maxwell ◽  
Edith P. Mitchell ◽  
Gerald A. Isenberg ◽  
...  
Keyword(s):  
Colonic Obstruction ◽  
Term Survival ◽  
Long Term Survival ◽  
Colonic Stenting ◽  
Malignant Colonic Obstruction

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.

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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