Skip to main content

Advertisement

SpringerLink
Log in

Obstructing Left-Sided Colonic Cancer: Is Endoscopic Stenting a Bridge to Surgery or a Bridge to Nowhere?

  • SIRC Invited Review
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

For the 8–29% colorectal cancers that initially manifest with obstruction, emergency surgery (ES) was traditionally considered the only available therapy, despite high morbidity and mortality rates and the need for colostomy creation. More recently, malignant obstruction of the left colon can be temporized by endoscopic placement of a self-expanding metallic stent (SEMS), used as bridge to surgery (BTS), facilitating a laparoscopic approach and increasing the likelihood that a primary anastomosis instead of stoma would be used. Despite these attractive outcomes, the superiority of the BTS approach is not clearly established. Few authors have stressed the potential cancer risk associated with perforations that may occur during endoscopic stent placement, facilitating neoplastic spread and negatively impacting prognosis. For this reason, the current literature focuses on long-term oncologic outcomes such as disease-free survival, overall survival and recurrence rate that do seem not to differ between the ES and BTS approaches. This lack of consensus has spawned differing and sometimes discordant guidelines worldwide. In conclusion, 20 years after the first description of a colonic stent as BTS, the debate is still open, but the growing number of articles about the use of SEMS as a BTS signifies a great interest in the topic. We hope that these data will finally converge on a single set of recommendations supporting a management strategy with well-demonstrated superiority.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

CRC:

Colorectal cancer

CT:

Computed tomography

SEMS:

Self-expandable metallic stent

ES:

Emergency surgery

BTS:

Bridge to surgery

MOF:

Multiorgan failure

MRI:

Magnetic resonance imaging

TS:

Technical success

CS:

Clinical success

ASGE:

American Society for Gastrointestinal Endoscopy

ESGE:

European Society of Gastrointestinal Endoscopy

PFS:

Progression-free survival

OS:

Overall survival

DFS:

Disease-free survival

References

  1. Brody H. Colorectal cancer. Nature. 2015;521:1.

    Google Scholar 

  2. Baer C, Menon R, Bastawrous S, et al. Emergency presentations of colorectal cancer. Surg Clin North Am. 2017;97:529–545.

    PubMed  Google Scholar 

  3. Lim T-Z, Tan K-K. Endoscopic stenting in colorectal cancer. J Gastrointest Oncol. 2019;10:1171–1182.

    PubMed  PubMed Central  Google Scholar 

  4. Trigui A, Rejab H, Akrout A, et al. Comparaison entre stent endoscopique et colostomie pour les cancers coliques gauches en obstruction: revue de la littérature. Presse Médicale. 2019;48:173–180. (article in French).

    Google Scholar 

  5. Tanis PJ, Paulino Pereira NR, van Hooft JE, Dutch Surgical Colorectal Audit, et al. Resection of obstructive left-sided colon cancer at a national level: a prospective analysis of short-term outcomes in 1,816 patients. Dig Surg. 2015;32:317–324.

    PubMed  Google Scholar 

  6. Bakker IS, Snijders HS, Grossmann I, et al. High mortality rates after nonelective colon cancer resection: results of a national audit. Colorectal Dis. 2016;18:612–621.

    CAS  PubMed  Google Scholar 

  7. Fugazza A, Galtieri PA, Repici A. Using stents in the management of malignant bowel obstruction: the current situation and future progress. Expert Rev Gastroenterol Hepatol. 2017;11:633–641.

    CAS  PubMed  Google Scholar 

  8. Veld JV, Amelung FJ, Borstlap WAA, et al. Changes in management of left-sided obstructive colon cancer: national practice and guideline implementation. J Natl Compr Cancer Netw. 2019;17:1512–1520.

    Google Scholar 

  9. Tejero E, Mainar A, Fernández L, et al. New procedure for the treatment of colorectal neoplastic obstructions. Dis Colon Rectum. 1994;37:1158–1159.

    CAS  PubMed  Google Scholar 

  10. Targownik LE, Spiegel BM, Sack J, et al. Colonic stent vs. emergency surgery for management of acute left-sided malignant colonic obstruction: a decision analysis. Gastrointest Endosc. 2004;60:865–874.

    PubMed  Google Scholar 

  11. Allievi N, Ceresoli M, Fugazzola P, et al. Endoscopic stenting as bridge to surgery versus emergency resection for left-sided malignant colorectal obstruction: an updated meta-analysis. Int J Surg Oncol. 2017;2017:1–11.

    Google Scholar 

  12. Furuke H, Komatsu S, Ikeda J, et al. Self-expandable metallic stents contribute to reducing perioperative complications in colorectal cancer patients with acute obstruction. Anticancer Res. 2018;38:1749–1753.

    PubMed  Google Scholar 

  13. Ng H, Yule M, Twoon M, et al. Current outcomes of emergency large bowel surgery. Ann R Coll Surg Engl. 2015;97:151–156.

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Kundes F, Kement M, Cetin K, et al. Evaluation of the patients with colorectal cancer undergoing emergent curative surgery. SpringerPlus. 2016;5:2024.

    PubMed  PubMed Central  Google Scholar 

  15. Trompetas V. Emergency management of malignant acute left-sided colonic obstruction. Ann R Coll Surg Engl. 2008;90:181–186.

    PubMed  PubMed Central  Google Scholar 

  16. Koruth NM, Hunter DC, Krukowski ZH, et al. Immediate resection in emergency large bowel surgery: a 7 year audit. Br J Surg. 1985;72:703–707.

    CAS  PubMed  Google Scholar 

  17. Carraro PG, Segala M, Orlotti C, et al. Outcome of large-bowel perforation in patients with colorectal cancer. Dis Colon Rectum. 1998;41:1421–1426.

    CAS  PubMed  Google Scholar 

  18. Hayakawa K, Tanikake M, Yoshida S, et al. Radiological diagnosis of large-bowel obstruction: non neoplastic etiology. Jpn J Radiol. 2012;30:541–552.

    PubMed  Google Scholar 

  19. Wolff BG, American Society of Colon and Rectal Surgeons. The ASCRS Textbook of Colon and Rectal Surgery. New York: Springer; 2007:810.

    Google Scholar 

  20. Teixeira F, Akaishi EH, Ushinohama AZ, et al. Can we respect the principles of oncologic resection in an emergency surgery to treat colon cancer? World J Emerg Surg. 2015;10:5.

    PubMed  PubMed Central  Google Scholar 

  21. Xu Z, Becerra AZ, Aquina CT, et al. Emergent colectomy is independently associated with decreased long-term overall survival in colon cancer patients. J Gastrointest Surg. 2017;21:543–553.

    PubMed  Google Scholar 

  22. Tonini V, Birindelli A, Bianchini S, et al. Factors affecting the number of lymph nodes retrieved after colo-rectal cancer surgery: a prospective single-centre study. Surgeon. 2020;18:31–36.

    PubMed  Google Scholar 

  23. Menegozzo CAM, Teixeira-Júnior F, Couto-Netto SDD, et al. Outcomes of elderly patients undergoing emergency surgery for complicated colorectal cancer: a retrospective cohort study. Clinics. 2019;74:e1074.

    PubMed  PubMed Central  Google Scholar 

  24. Yang L, Xiong Z, Xie Q, et al. Prognostic value of total number of lymph nodes retrieved differs between left-sided colon cancer and right-sided colon cancer in stage III patients with colon cancer. BMC Cancer. 2018;18:558.

    PubMed  PubMed Central  Google Scholar 

  25. Aslar AK, Ozdemir S, Mahmoudi H, et al. Analysis of 230 cases of emergent surgery for obstructing colon cancer—lessons learned. J Gastrointest Surg. 2011;15:110–119.

    PubMed  Google Scholar 

  26. Racz J, Dubois L, Katchky A, et al. Elective and emergency abdominal surgery in patients 90 years of age or older. Can J Surg. 2012;55:322–328.

    PubMed  PubMed Central  Google Scholar 

  27. Hogan J, Samaha G, Burke J, et al. Emergency presenting colon cancer is an independent predictor of adverse disease-free survival. Int Surg. 2015;100:77–86.

    PubMed  PubMed Central  Google Scholar 

  28. Gash K, Chambers W, Ghosh A, et al. The role of laparoscopic surgery for the management of acute large bowel obstruction. Colorectal Dis. 2011;13:263–266.

    CAS  PubMed  Google Scholar 

  29. Guillou PJ, Quirke P, Thorpe H, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005;365:1718–1726.

    PubMed  Google Scholar 

  30. Rozen P, Liphshitz I, Barchana M. The changing epidemiology of colorectal cancer and its relevance for adapting screening guidelines and methods. Eur J Cancer Prev. 2011;20:46–53.

    PubMed  Google Scholar 

  31. Frago R, Ramirez E, Millan M, et al. Current management of acute malignant large bowel obstruction: a systematic review. Am J Surg. 2014;207:127–138.

    PubMed  Google Scholar 

  32. Biondo S, Parés D, Kreisler E, et al. Anastomotic dehiscence after resection and primary anastomosis in left-sided colonic emergencies. Dis Colon Rectum. 2005;48:2272–2280.

    PubMed  Google Scholar 

  33. Dohmoto M, Hünerbein M, Schlag PM. Application of rectal stents for palliation of obstructing rectosigmoid cancer. Surg Endosc. 1997;11:758–761.

    CAS  PubMed  Google Scholar 

  34. Seo SY, Kim SW. Endoscopic management of malignant colonic obstruction. Clin Endosc. 2020;53:9–17.

    PubMed  PubMed Central  Google Scholar 

  35. de Gregorio MA, Mainar A, Rodriguez J, et al. Colon stenting: a review. Semin Interv Radiol. 2004;21:205–216.

    Google Scholar 

  36. Kim EJ, Kim YJ. Stents for colorectal obstruction: past, present, and future. World J Gastroenterol. 2016;22:842–852.

    CAS  PubMed  PubMed Central  Google Scholar 

  37. Tonolini M, Bareggi E, Salerno R. Endoscopic stenting of malignant, benign and iatrogenic colorectal disorders: a primer for radiologists. Insights Imaging. 2019;10:80.

    PubMed  PubMed Central  Google Scholar 

  38. Sebastian S, Johnston S, Geoghegan T, et al. Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol. 2004;99:2051–2057.

    PubMed  Google Scholar 

  39. Harrison ME, Anderson MA, Appalaneni V, et al. The role of endoscopy in the management of patients with known and suspected colonic obstruction and pseudo-obstruction. Gastrointest Endosc. 2010;7:669–679.

    Google Scholar 

  40. Gallo G, Sammarco G, Chiriatti AP, et al. The role of self-expandable metallic stents as «bridge to surgery» for the treatment of acute malignant colorectal obstruction. Our experience. Ann Ital Chir.. 2017;6:418–424.

    PubMed  Google Scholar 

  41. Cetinkaya E, Dogrul AB, Tirnaksiz MB. Role of self expandable stents in management of colorectal cancers. World J Gastrointest Oncol. 2016;8:113–120.

    PubMed  PubMed Central  Google Scholar 

  42. Kim H, Kim SH, Choi SY, et al. Fluoroscopically guided placement of self-expandable metallic stents and stent-grafts in the treatment of acute malignant colorectal obstruction. J Vasc Interv Radiol. 2008;19:1709–1716.

    PubMed  Google Scholar 

  43. Geraghty J, Sarkar S, Cox T, et al. Management of large bowel obstruction with self-expanding metal stents. A multicentre retrospective study of factors determining outcome. Colorectal Dis. 2014;16:476–483.

    CAS  PubMed  Google Scholar 

  44. van Hooft JE, van Halsema EE, Vanbiervliet G, et al. Self-expandable metal stents for obstructing colonic and extracolonic cancer: european Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Gastrointest Endosc. 2014;80:747–761.

    PubMed  Google Scholar 

  45. Gargallo CJ, Ferrandez A, Carrera P, et al. Short- and long-term clinical outcomes of self-expandable metal stents inserted for colorectal obstruction and efficacy of different insertion techniques. Gastroenterol Hepatol. 2019;42:157–163.

    PubMed  Google Scholar 

  46. Lee J-M, Byeon J-S. Colorectal stents: current status. Clin Endosc. 2015;48:194.

    PubMed  PubMed Central  Google Scholar 

  47. Zhang Y, Shi J, Shi B, et al. Comparison of efficacy between uncovered and covered self-expanding metallic stents in malignant large bowel obstruction: a systematic review and meta-analysis. Colorectal Dis. 2012;14:e367–e374.

    CAS  PubMed  Google Scholar 

  48. Kim BC, Han KS, Hong CW, et al. Clinical outcomes of palliative self-expanding metallic stents in patients with malignant colorectal obstruction. J Dig Dis. 2012;13:258–266.

    PubMed  Google Scholar 

  49. Baron TH, Song LMWK, Repici A. Role of self-expandable stents for patients with colon cancer (with videos). Gastrointest Endosc. 2012;75:653–662.

    PubMed  Google Scholar 

  50. Lee HJ, Hong SP, Cheon JH, et al. Long-term outcome of palliative therapy for malignant colorectal obstruction in patients with unresectable metastatic colorectal cancers: endoscopic stenting versus surgery. Gastrointest Endosc. 2011;73:535–542.

    PubMed  Google Scholar 

  51. Datye A, Hersh J. Colonic perforation after stent placement for malignant colorectal obstruction–causes and contributing factors. Minim Invasive Ther Allied Technol. 2011;20:133–140.

    PubMed  Google Scholar 

  52. van Hooft JE, Fockens P, Marinelli AW, et al. Early closure of a multicenter randomized clinical trial of endoscopic stenting versus surgery for stage IV left-sided colorectal cancer. Endoscopy. 2008;40:184–191.

    PubMed  Google Scholar 

  53. Pirlet IA, Slim K, Kwiatkowski F, et al. Emergency preoperative stenting versus surgery for acute left-sided malignant colonic obstruction: a multicenter randomized controlled trial. Surg Endosc. 2011;25:1814–1821.

    PubMed  Google Scholar 

  54. Maruthachalam K, Lash GE, Shenton BK, et al. Tumour cell dissemination following endoscopic stent insertion. Br J Surg. 2007;94:1151–1154.

    CAS  PubMed  Google Scholar 

  55. Yamashita S, Tanemura M, Sawada G, et al. Impact of endoscopic stent insertion on detection of viable circulating tumor cells from obstructive colorectal cancer. Oncol Lett. 2017;15:400–406.

    PubMed  PubMed Central  Google Scholar 

  56. Cao Y, Deng S, Wu K, et al. Oncological consequence of emergent resection of perforated colon cancer with complete obstruction after stent insertion as a bridge to surgery. Int J Colorectal Dis. 2019;34:545–547.

    PubMed  Google Scholar 

  57. Imbulgoda A, MacLean A, Heine J, et al. Colonic perforation with intraluminal stents and bevacizumab in advanced colorectal cancer: retrospective case series and literature review. Can J Surg. 2015;58:167–171.

    PubMed  PubMed Central  Google Scholar 

  58. Lee JH, Emelogu I, Kukreja K, et al. Safety and efficacy of metal stents for malignant colonic obstruction in patients treated with bevacizumab. Gastrointest Endosc. 2019;90:125–126.

    Google Scholar 

  59. Ormando VM, Palma R, Fugazza A, et al. Colonic stents for malignant bowel obstruction: current status and future prospects. Expert Rev Med Dev. 2019;16:1053–1061.

    CAS  Google Scholar 

  60. Morita S, Yamamoto K, Ogawa A, et al. Benefits of using a self-expandable metallic stent as a bridge to surgery for right- and left-sided obstructive colorectal cancers. Surg Today. 2019;49:32–37.

    PubMed  Google Scholar 

  61. Endoscopy and Cancer Committee of the French Society of Digestive Endoscopy (SFED), French Federation of Digestive Oncology (FFCD). Place of colorectal stents in therapeutic management of malignant large bowel obstructions. Endoscopy. 2014;46:546–552.

    Google Scholar 

  62. Dastur JK, Forshaw MJ, Modarai B, et al. Comparison of short-and long-term outcomes following either insertion of self-expanding metallic stents or emergency surgery in malignant large bowel obstruction. Tech Coloproctol. 2008;12:51–55.

    CAS  PubMed  Google Scholar 

  63. Broholm M, Kobborg M, Frostberg E, et al. Delay of surgery after stent placement for resectable malignant colorectal obstruction is associated with higher risk of recurrence. Int J Colorectal Dis. 2017;32:513–516.

    PubMed  Google Scholar 

  64. Webster PJ, Aldoori J, Burke DA. Optimal management of malignant left-sided large bowel obstruction: do international guidelines agree? World J Emerg Surg.. 2019;14:23.

    PubMed  PubMed Central  Google Scholar 

  65. Benson AB, Arnoletti JP, Bekaii-Saab T, et al. Colon cancer. J Natl Compr Cancer Netw. 2011;9:1238–1290.

    CAS  Google Scholar 

  66. Ferrada P, Patel M, Poylin V, et al. Surgery or stenting for colonic obstruction: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2016;80:659–664.

    PubMed  Google Scholar 

  67. Vogel JD, Eskicioglu C, Weiser MR, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the treatment of colon cancer. Dis Colon Rectum. 2017;60:999–1017.

    PubMed  Google Scholar 

  68. van de Velde CJH, Boelens PG, Borras JM, et al. EURECCA colorectal: multidisciplinary management: European consensus conference colon & rectum. Eur J Cancer. 2014;50:1.e1–1.e34.

    Google Scholar 

  69. Costa G, Ruscelli P, Balducci G, et al. Clinical strategies for the management of intestinal obstruction and pseudo-obstruction. A Delphi Consensus study of SICUT (Società Italiana di Chirurgia d’Urgenza e del Trauma). Ann Ital Chir. 2016;87:105–117.

    PubMed  Google Scholar 

  70. Pisano M, Zorcolo L, Merli C, et al. 2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation. World J Emerg Surg. 2018;13:36.

    PubMed  PubMed Central  Google Scholar 

  71. Zhang Y, Shi J, Shi B, et al. Self-expanding metallic stent as a bridge to surgery versus emergency surgery for obstructive colorectal cancer: a meta-analysis. Surg Endosc. 2012;26:110–119.

    CAS  PubMed  Google Scholar 

  72. Cirocchi R, Farinella E, Trastulli S, et al. Safety and efficacy of endoscopic colonic stenting as a bridge to surgery in the management of intestinal obstruction due to left colon and rectal cancer: a systematic review and meta-analysis. Surg Oncol. 2013;22:14–21.

    PubMed  Google Scholar 

  73. De Ceglie A, Filiberti R, Baron TH, et al. A meta-analysis of endoscopic stenting as bridge to surgery versus emergency surgery for left-sided colorectal cancer obstruction. Crit Rev Oncol Hematol. 2013;88:387–403.

    PubMed  Google Scholar 

  74. Huang X, Lv B, Zhang S, et al. Preoperative colonic stents versus emergency surgery for acute left-sided malignant colonic obstruction: a meta-analysis. J Gastrointest Surg. 2014;18:584–591.

    PubMed  Google Scholar 

  75. Arezzo A, Passera R, Lo Secco G, et al. Stent as bridge to surgery for left-sided malignant colonic obstruction reduces adverse events and stoma rate compared with emergency surgery: results of a systematic review and meta-analysis of randomized controlled trials. Gastrointest Endosc. 2017;86:416–426.

    PubMed  Google Scholar 

  76. Consolo P, Giacobbe G, Cintolo M, et al. Colonic acute malignant obstructions: effectiveness of self-expanding metallic stent as bridge to surgery. Turk J Gastroenterol. 2017;28:40–45.

    PubMed  Google Scholar 

  77. Boland PA, Kelly ME, Donlon NE, et al. Outcomes following colonic stenting for malignant left-sided bowel obstruction: a systematic review of randomised controlled trials. Int J Colorectal Dis. 2019;34:1625–1632.

    PubMed  Google Scholar 

  78. Donlon NE, Kelly ME, Narouz F, et al. Colonic stenting as a bridge to surgery in malignant large bowel obstruction: oncological outcomes. Int J Colorectal Dis. 2019;34:613–619.

    CAS  PubMed  Google Scholar 

  79. Cheung HYS, Chung CC, Tsang WWC, et al. Endolaparoscopic approach vs conventional open surgery in the treatment of obstructing left-sided colon cancer: a randomized controlled trial. Arch Surg. 2009;144:1127–1132.

    PubMed  Google Scholar 

  80. Ho K-S, Quah H-M, Lim J-F, et al. Endoscopic stenting and elective surgery versus emergency surgery for left-sided malignant colonic obstruction: a prospective randomized trial. Int J Colorectal Dis. 2012;27:355–362.

    PubMed  Google Scholar 

  81. Kim JS, Hur H, Min BS, et al. Oncologic outcomes of self-expanding metallic stent insertion as a bridge to surgery in the management of left-sided colon cancer obstruction: comparison with non obstructing elective surgery. World J Surg. 2009;33:1281–1286.

    PubMed  Google Scholar 

  82. Matsuda A, Miyashita M, Matsumoto S, et al. Comparison of long-term outcomes of colonic stent as “Bridge to Surgery” and emergency surgery for malignant large-bowel obstruction: a meta-analysis. Ann Surg Oncol. 2015;22:497–504.

    PubMed  Google Scholar 

  83. Quereshy FA, Poon JTC, Law WL. Long-term outcome of stenting as a bridge to surgery for acute left-sided malignant colonic obstruction. Colorectal Dis. 2014;16:788–793.

    CAS  PubMed  Google Scholar 

  84. Kim MK, Kye B-H, Lee IK, et al. Outcome of bridge to surgery stenting for obstructive left colon cancer: long-term outcome of stent insertion. ANZ J Surg. 2017;87:E245–E250.

    PubMed  Google Scholar 

  85. Arezzo A, Balague C, Targarona E, et al. Colonic stenting as a bridge to surgery versus emergency surgery for malignant colonic obstruction: results of a multicentre randomised controlled trial (ESCO trial). Surg Endosc. 2017;31:3297–3305.

    PubMed  Google Scholar 

  86. Gibor U, Perry Z, Tirosh D, et al. Comparison of the long-term oncological outcomes of stent as a bridge to surgery and surgery alone in malignant colonic obstruction. Isr Med Assoc J. 2017;19:736–740.

    PubMed  Google Scholar 

  87. Verstockt B, Van Driessche A, De Man M, et al. Ten-year survival after endoscopic stent placement as a bridge to surgery in obstructing colon cancer. Gastrointest Endosc. 2018;87:705–713.

    PubMed  Google Scholar 

  88. Amelung FJ, Burghgraef TA, Tanis PJ, et al. Critical appraisal of oncological safety of stent as bridge to surgery in left-sided obstructing colon cancer; a systematic review and meta-analysis. Crit Rev Oncol Hematol. 2018;131:66–75.

    PubMed  Google Scholar 

  89. Foo CC, Poon SHT, Chiu RHY, et al. Is bridge to surgery stenting a safe alternative to emergency surgery in malignant colonic obstruction: a meta-analysis of randomized control trials. Surg Endosc. 2019;33:293–302.

    PubMed  Google Scholar 

  90. Alcántara M, Serra-Aracil X, Falcó J, et al. Prospective, controlled, randomized study of intraoperative colonic lavage versus stent placement in obstructive left-sided colonic cancer. World J Surg. 2011;35:1904–1910.

    PubMed  Google Scholar 

  91. Harvey PR, Rees J, Baldwin S, et al. Outcomes of colorectal stents when used as a bridge to curative resection in obstruction secondary to colorectal cancer. Int J Colorectal Dis. 2019;34:1295–1302.

    PubMed  Google Scholar 

  92. Yang SY, Park YY, Han YD, et al. Oncologic outcomes of self-expandable metallic stent as a bridge to surgery and safety and feasibility of minimally invasive surgery for acute malignant colonic obstruction. Ann Surg Oncol. 2019;26:2787–2796.

    PubMed  Google Scholar 

  93. Cao Y, Gu J, Deng S, et al. Long-term tumour outcomes of self-expanding metal stents as ‘bridge to surgery’ for the treatment of colorectal cancer with malignant obstruction: a systematic review and meta-analysis. Int J Colorectal Dis. 2019;34:1827–1838.

    PubMed  Google Scholar 

  94. Wang X, He J, Chen X, et al. Stenting as a bridge to resection versus emergency surgery for left-sided colorectal cancer with malignant obstruction: a systematic review and meta-analysis. Int J Surg. 2017;48:64–68.

    PubMed  Google Scholar 

  95. Rodrigues-Pinto E, Morais R, Coelho C, et al. Bridge-to-surgery versus emergency surgery in the management of left-sided acute malignant colorectal obstruction—efficacy, safety and long-term outcomes. Dig Liver Dis. 2019;51:364–372.

    PubMed  Google Scholar 

  96. Yang P, Lin X-F, Lin K, et al. Role of stents as bridge to surgery for acute left-sided obstructive colorectal cancer: meta-analysis of randomized controlled trials. Rev Invest Clin. 2018;70:269–278.

    PubMed  Google Scholar 

  97. Ribeiro IB, de Moura DTH, Sachdev AH, et al. Stent as a bridge to surgery for colonic obstruction: do we really need more systematic reviews with meta-analysis of the same articles? Gastrointest Endosc. 2019;90:704–705.

    PubMed  Google Scholar 

  98. Arezzo A, Lo Secco G, Passera R, et al. Response: gastrointestinal endoscopy. Gastrointest Endosc. 2019;90:705–706.

    PubMed  Google Scholar 

Download references

Acknowledgment

We wish to thank Mrs. Claudia Cirillo (M.A. in English and Consultant for Strategic Affairs—Thomas Jefferson University—Philadelphia—PA—USA) for her English language editing of our text.

Author information

Authors and Affiliations

  1. Emergency Surgery Department, St. Orsola University Hospital, Bologna, Italy

    Augusto Lauro, Margherita Binetti, Maurizio Cervellera & Valeria Tonini

  2. Department of Surgical Sciences, Umberto I University Hospital - La Sapienza, Rome, Italy

    Samuele Vaccari

Authors
  1. Augusto Lauro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Margherita Binetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Samuele Vaccari
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maurizio Cervellera
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Valeria Tonini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Samuele Vaccari.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lauro, A., Binetti, M., Vaccari, S. et al. Obstructing Left-Sided Colonic Cancer: Is Endoscopic Stenting a Bridge to Surgery or a Bridge to Nowhere?. Dig Dis Sci 65, 2789–2799 (2020). https://doi.org/10.1007/s10620-020-06403-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-020-06403-2

Keywords

Search

Navigation