Self-expanding metallic stent as a bridge to surgery versus emergency surgery for acute obstructive colorectal cancer: a retrospective study

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

10.21203/rs.3.rs-43717/v3 ◽

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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Current Status of “Bridge to Surgery” Using a Self-expandable Metallic Stent for Obstructive Colorectal Cancer

Nippon Daicho Komonbyo Gakkai Zasshi ◽

10.3862/jcoloproctology.73.410 ◽

2020 ◽

Vol 73 (10) ◽

pp. 410-416

Author(s):

Akihisa Matsuda ◽

Takeshi Yamada ◽

Satoshi Matsumoto ◽

Seiichi Shinji ◽

Ryo Ohta ◽

...

Keyword(s):

Colorectal Cancer ◽

Current Status ◽

Metallic Stent ◽

Bridge To Surgery ◽

Obstructive Colorectal Cancer ◽

Expandable Metallic Stent

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Bridge to Surgery Using a Self-Expandable Metallic Stent for Stages II–III Obstructive Colorectal Cancer

10.21203/rs.3.rs-33523/v1 ◽

2020 ◽

Author(s):

Katsuya Ohta ◽

Masakazu Ikenaga ◽

Masami Ueda ◽

Kiyotsugu Iede ◽

Yujiro Tsuda ◽

...

Keyword(s):

Colorectal Cancer ◽

Overall Survival ◽

Venous Invasion ◽

Stage Ii ◽

Rank Test ◽

Metallic Stent ◽

Bridge To Surgery ◽

Sems Placement ◽

Obstructive Colorectal Cancer ◽

Expandable Metallic Stent

Abstract Background: Bridge to surgery (BTS) using a self-expandable metallic stent (SEMS) for the treatment of obstructive colorectal cancer improves the patient’s quality of life. This study aimed to examine prognostic factors of obstructive colorectal cancer. Methods: We analyzed stage II-III resectable colon cancer cases (Cur A) retrospectively registered between January 2005 and 2017. We encountered Cur A cases after BTS with SEMS placement (BTS group). We compared surgical results and prognoses between the two groups. Results: A total of 50 patients underwent endoscopic SEMS placement, which technical success of 96% and morbidity rate of 18%. Overall, 117 patients were evaluated: 67 of them underwent emergency surgery (ES) and 50 underwent BTS. Primary anastomosis rates were 77.6% in ES and 95.7% in BTS (p < 0.001); postoperative complication, 46.3% in ES and 10.5% in BTS (p < 0.001); pathological findings of lymphatic invasion, 66.7% in ES and 100% in BTS (p < 0.001); venous invasion were 66.8% in ES and 92% in BTS (p = 0.04); and recurrence of 25.4% in ES and 39.1% in BTS. The 3-year overall survival was significantly different between two groups (ES, 86.8%:BTS, 58.8%), BTS is worse than ES (log-rank test; p < 0.001). Venous invasion independently predicted worsened recurrence-free and overall survival. Conclusions: The vascular invasiveness was correlated with tumor progression after SEMS placement, and the survival rate was lower in BTS. SEMS potentially worsens prognostic outcomes in stage II–III obstructive colorectal cancer.

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Comparison of the Oncological Outcomes of Stenting as a Bridge to Surgery and Surgery Alone in Stages II to III Obstructive Colorectal Cancer: A Retrospective Study

Annals of Coloproctology ◽

10.3393/ac.2020.01067.0152 ◽

2021 ◽

Author(s):

Hiroaki Uehara ◽

Toshiyuki Yamazaki ◽

Akira Iwaya ◽

Hitoshi Kameyama ◽

Masaru Komatsu ◽

...

Keyword(s):

Colorectal Cancer ◽

Retrospective Study ◽

Bridge To Surgery ◽

Oncological Outcomes ◽

Obstructive Colorectal Cancer

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

10.21203/rs.3.rs-43717/v2 ◽

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 SMES 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 ofperineural 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, it should not be considered as the first treatment for radically resectable colorectal cancer.

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Short-term outcomes of laparoscopic surgery after insertion of self-expandable metallic stent as a “bridge to surgery” for left-sided obstructive colorectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.3_suppl.643 ◽

2014 ◽

Vol 32 (3_suppl) ◽

pp. 643-643

Author(s):

Yuhei Waki ◽

Kazunori Tokuda ◽

Masayoshi Obatake ◽

Miya Nagahashi ◽

Masanori Hotchi ◽

...

Keyword(s):

Colorectal Cancer ◽

Laparoscopic Surgery ◽

Blood Loss ◽

Hospital Stay ◽

Metallic Stent ◽

Bridge To Surgery ◽

Short Term ◽

Obstructive Colorectal Cancer ◽

Expandable Metallic Stent ◽

Significant Difference

643 Background: Safety and validity of performing laparoscopic surgery after preoperative lavege using the self-expandable metallic stent (SEMS) for left-sided obstructive colorectal cancer were examined. We evaluated the short-term outcome of SEMS insertion compared with laparoscopic surgery without SEMS. Methods: Patients with left-sided colorectal cancer treated by either laparoscopic surgery with stent placement (n = 8) or laparoscopic surgery only (n = 42) in our hospital between April, 2012 and January, 2013 were registered. Short-term outcomes were compared with the two groups about patient characteristics (sex, age, American Society of Anesthesiologists Physical Status, body mass index, prior abdominal surgery), pathological data of patients (tumor location, size of tumor , tumor differentiation, number of harvested lymph nodes, pTNM classification, UICC pathological stage), and operative and post operative results (procedures, conversion, operative time, blood loss, morbidity, solid food intake, postoperative hospital stay, total hospital stay). Results: Except for tumor size in the patient characteristic parameters, there were no statistically significant difference between the two groups. Conversion rate to laparotomy was higher in the stent group (2 versus 1, p = 0.013). There was no difference in operation time, blood loss and postoperative complications between the two groups. Conclusions: Although the long-term oncological result requires further investigation, laparoscopic surgery after self-expandable metallic stent is a safe and feasible treatment as a “brige to surgery” for left-sided obstructive colorectal cancer.

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Comparison of the Oncological Outcomes of Stenting as a Bridge to Surgery and Surgery Alone in Stages II-III Obstructive Colorectal Cancer; A Retrospective Study

10.21203/rs.3.rs-73129/v1 ◽

2020 ◽

Author(s):

Hiroaki Uehara ◽

Toshiyuki Yamazaki ◽

Akira Iwaya ◽

Hitoshi Kameyama ◽

Rina Harada ◽

...

Keyword(s):

Colorectal Cancer ◽

Emergency Surgery ◽

Survival Rates ◽

Clinical Success Rate ◽

Trial Registration ◽

Bridge To Surgery ◽

Recurrence Rates ◽

Metastatic Recurrence ◽

Oncological Outcomes ◽

Obstructive Colorectal Cancer

Abstract Background: The Japanese Society for Cancer of the Colon and Rectum guidelines in 2019, stated that stenting as a bridge to surgery (BTS) for obstructive cancer may cause perforation and other adverse effects, which may worsen the long‑term prognosis. This study aimed to evaluate retrospectively the surgical and oncological outcomes of BTS using a stent compared with surgery alone for obstructive colorectal cancer.Methods: Consecutive patients who underwent curative resection for stages II-III obstructive colorectal cancer at our institution from January 2009 to March 2020, were registered retrospectively and divided into 43 patients in the BTS group and 65 patients in the surgery alone group. We compared the surgical and oncological outcomes between the two groups.Results: Stent-related perforation did not occur in any patient. The patient in whom the stent placement was unsuccessful underwent emergency surgery with poor decompression even after SEMS placement (clinical success rate, 97.4%). The pathological characteristics were not significantly different between the groups. The following surgical outcomes in the BTS group were superior to those in the surgery alone group: non-emergency surgery (P < 0.001), surgical approach (P = 0.006), and length of hospital stay (P = 0.020). The median follow-up time was 44.9 months (range, 1.1 - 126.5 months). The 3-year relapse-free survival rates were 68.4% and 58.2% (P = 0.411), and the overall survival rates were 78.3% and 88.2% (P = 0.255) in the surgery alone and BTS groups, respectively. The 3-year locoregional recurrence rates were 10.2% and 8.0% (P = 0.948), and distant metastatic recurrence rates were 13.3% and 30.4% (P = 0.035) in the surgery alone and BTS groups, respectively. Conclusion: This study revealed that BTS with stent may be associated with a higher frequency of distant metastatic recurrence. Stent for stages II-III obstructive colorectal cancer potentially worsens oncological outcomes.Trial registration: This study was registered retrospectively in University hospital Medical Information Network (UMIN)- Clinical Trials Registry. (Trial registration: UMIN, UMIN000040771. Registered 15 June 2020 - Retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/icdr/ctr_view.cgi?recptno=R000046558).

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