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Comparison of Long-Term Outcomes of Colonic Stent as “Bridge to Surgery” and Emergency Surgery for Malignant Large-Bowel Obstruction: A Meta-Analysis

Annals of Surgical Oncology volume 22, pages 497–504 (2015)Cite this article

Abstract

Background

The short-term safety and efficacy of insertion of a self-expandable metallic colonic stent followed by elective surgery, bridge to surgery (BTS), for malignant large-bowel obstruction (MLBO) have been well described. However, long-term oncological outcomes are still debated. Hence, this study is conducted to evaluate long-term outcomes of colonic stent insertion followed by surgery for MLBO.

Methods

A comprehensive electronic literature search through May 2014 was performed to identify studies comparing long-term outcomes between BTS and emergency surgery for MLBO. The main outcome measures were overall survival (OS), disease-free survival (DFS), and recurrence. A meta-analysis was performed using random-effects models to calculate risk ratios (RRs) with 95 % confidence intervals (95 % CIs).

Results

There were 11 studies that matched the criteria for inclusion, yielding a total of 1136 patients, of whom 432 (38.0 %) underwent BTS and 704 (62.0 %) underwent emergency surgery. In OS analyses of all patients and patients who underwent curative resection, BTS was similar to emergency surgery [(RR = 0.95; 95 % CI 0.75–1.21; P = 0.66) (RR = 0.96; 95 % CI 0.67–1.37; P = 0.82), respectively]. DFS (RR = 1.06; 95 % CI 0.91–1.24; P = 0.43) and recurrence (RR = 1.13; 95 % CI 0.82–1.54; P = 0.46) did not differ significantly between the BTS and emergency surgery groups.

Conclusions

Results of this meta-analysis on long-term as well as well-described short-term outcomes suggest that BTS could be a promising alternative strategy for MLBO patients.

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References

  1. Deans GT, Krukowski ZH, Irwin ST. Malignant obstruction of the left colon. Br J Surg. 1994;81:1270–6.

    CAS  PubMed  Article  Google Scholar 

  2. Yeo HL, Lee SW. Colorectal emergencies: review and controversies in the management of large bowel obstruction. J Gastrointest Surg. 2013;17:2007–12.

    PubMed  Article  Google Scholar 

  3. Tekkis PP, Kinsman R, Thompson MR, Stamatakis JD, Association of Coloproctology of Great Britain I. The Association of Coloproctology of Great Britain and Ireland study of large bowel obstruction caused by colorectal cancer. Ann Surg. 2004;240:76–81.

    PubMed Central  PubMed  Article  Google Scholar 

  4. Korenaga D, Ueo H, Mochida K, Kusumoto T, Baba H, Tamura S, et al. Prognostic factors in Japanese patients with colorectal cancer: the significance of large bowel obstruction–univariate and multivariate analyses. J Surg Oncol. 1991;47:188–92.

    CAS  PubMed  Article  Google Scholar 

  5. Runkel NS, Schlag P, Schwarz V, Herfarth C. Outcome after emergency surgery for cancer of the large intestine. Br J Surg. 1991;78:183–8.

    CAS  PubMed  Article  Google Scholar 

  6. Dohmoto M. New method: endoscopic implantation of rectal stent in palliative treatment of malignant stenosis. Endosc Dig. 1991;3:1507–12.

    Google Scholar 

  7. Dohmoto M, Hunerbein M, Schlag PM. Palliative endoscopic therapy of rectal carcinoma. Eur J Cancer. 1996;32A:25–9.

    CAS  PubMed  Article  Google Scholar 

  8. Cirocchi R, Farinella E, Trastulli S, Desiderio J, Listorti C, Boselli C, 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  Article  Google Scholar 

  9. Huang X, Lv B, Zhang S, Meng L. Preoperative colonic stents versus emergency surgery for acute left-sided malignant colonic obstruction: a meta-analysis. J Gastrointest Surg. 2014;18:584–91.

    PubMed  Article  Google Scholar 

  10. Tan CJ, Dasari BV, Gardiner K. Systematic review and meta-analysis of randomized clinical trials of self-expanding metallic stents as a bridge to surgery versus emergency surgery for malignant left-sided large bowel obstruction. Br J Surg. 2012;99:469–76.

    CAS  PubMed  Article  Google Scholar 

  11. Khot UP, Lang AW, Murali K, Parker MC. Systematic review of the efficacy and safety of colorectal stents. Br J Surg. 2002;89:1096–102.

    CAS  PubMed  Article  Google Scholar 

  12. Saida Y, Sumiyama Y, Nagao J, Takase M. Stent endoprosthesis for obstructing colorectal cancers. Dis Colon Rectum. 1996;39:552–5.

    CAS  PubMed  Article  Google Scholar 

  13. Vitale MA, Villotti G, d’Alba L, Frontespezi S, Iacopini F, Iacopini G. Preoperative colonoscopy after self-expandable metallic stent placement in patients with acute neoplastic colon obstruction. Gastrointest Endosc. 2006;63:814–9.

    PubMed  Article  Google Scholar 

  14. Koch M, Kienle P, Sauer P, Willeke F, Buhl K, Benner A, et al. Hematogenous tumor cell dissemination during colonoscopy for colorectal cancer. Surg Endosc. 2004;18:587–91.

    CAS  PubMed  Article  Google Scholar 

  15. Maruthachalam K, Lash GE, Shenton BK, Horgan AF. Tumour cell dissemination following endoscopic stent insertion. Br J Surg. 2007;94:1151–4.

    CAS  PubMed  Article  Google Scholar 

  16. Choi JM, Lee C, Han YM, Lee M, Choi YH, Jang DK, et al. Long-term oncologic outcomes of endoscopic stenting as a bridge to surgery for malignant colonic obstruction: comparison with emergency surgery. Surg Endosc. 2014;28:2649–55.

    PubMed  Article  Google Scholar 

  17. Gianotti L, Tamini N, Nespoli L, Rota M, Bolzonaro E, Frego R, et al. A prospective evaluation of short-term and long-term results from colonic stenting for palliation or as a bridge to elective operation versus immediate surgery for large-bowel obstruction. Surg Endosc. 2013;27:832–42.

    PubMed  Article  Google Scholar 

  18. Gorissen KJ, Tuynman JB, Fryer E, Wang L, Uberoi R, Jones OM, et al. Local recurrence after stenting for obstructing left-sided colonic cancer. Br J Surg. 2013;100:1805–9.

    CAS  PubMed  Article  Google Scholar 

  19. Quereshy FA, Poon JT, Law WL. Long-term outcome of stenting as a bridge to surgery for acute left-sided malignant colonic obstruction. Colorectal Dis. 2014; doi:10.1111/codi.12666. [Epub ahead of print].

  20. Sabbagh C, Browet F, Diouf M, Cosse C, Brehant O, Bartoli E, et al. Is stenting as “a bridge to surgery” an oncologically safe strategy for the management of acute, left-sided, malignant, colonic obstruction? A comparative study with a propensity score analysis. Ann Surg. 2013;258:107–15.

    PubMed  Article  Google Scholar 

  21. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.

    Article  Google Scholar 

  22. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–88.

    CAS  PubMed  Article  Google Scholar 

  23. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60.

    PubMed Central  PubMed  Article  Google Scholar 

  24. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–34.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  25. Abramson JH. WINPEPI updated: computer programs for epidemiologists, and their teaching potential. Epidemiol Perspect Innov. 2011;8:1.

    PubMed Central  PubMed  Article  Google Scholar 

  26. Alcantara M, Serra-Aracil X, Falco J, Mora L, Bombardo J, Navarro S. Prospective, controlled, randomized study of intraoperative colonic lavage versus stent placement in obstructive left-sided colonic cancer. World J Surg. 2011;35:1904–10.

    CAS  PubMed  Article  Google Scholar 

  27. Dastur JK, Forshaw MJ, Modarai B, Solkar MM, Raymond T, Parker MC. 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;12:51–5.

    CAS  PubMed  Article  Google Scholar 

  28. Kim HJ, Choi GS, Park JS, Park SY, Jun SH. Higher rate of perineural invasion in stent-laparoscopic approach in comparison to emergent open resection for obstructing left-sided colon cancer. Int J Colorectal Dis. 2013;28:407–14.

    PubMed  Article  Google Scholar 

  29. Saida Y, Sumiyama Y, Nagao J, Uramatsu M. Long-term prognosis of preoperative “bridge to surgery” expandable metallic stent insertion for obstructive colorectal cancer: comparison with emergency operation. Dis Colon Rectum. 2003;46:S44–9.

    PubMed  Google Scholar 

  30. Tung KL, Cheung HY, Ng LW, Chung CC, Li MK. Endo-laparoscopic approach versus conventional open surgery in the treatment of obstructing left-sided colon cancer: long-term follow-up of a randomized trial. Asian J Endosc Surg. 2013;6:78–81.

    PubMed  Article  Google Scholar 

  31. Xu K, Zhang H, Feng Y, Cong JC, Chen CS, Liu EQ. Comparison of the outcomes of preoperative stent insertion and emergency surgery in the treatment of obstructive left-sided colorectal cancer: an analysis of 248 cases (in Chinese). Shijie Huaren Xiaohua Zazhi. 2010;18:736–40.

    Google Scholar 

  32. Zhang Y, Shi J, Shi B, Song CY, Xie WF, Chen YX. Self-expanding metallic stent as a bridge to surgery versus emergency surgery for obstructive colorectal cancer: a meta-analysis. Surg Endosc. 2012;26:110–9.

    CAS  PubMed  Article  Google Scholar 

  33. Sabbagh C, Chatelain D, Trouillet N, Mauvais F, Bendjaballah S, Browet F, et al. Does use of a metallic colon stent as a bridge to surgery modify the pathology data in patients with colonic obstruction? A case-matched study. Surg Endosc. 2013;27:3622–31.

    Google Scholar 

  34. Pirlet IA, Slim K, Kwiatkowski F, Michot F, Millat BL. Emergency preoperative stenting versus surgery for acute left-sided malignant colonic obstruction: a multicenter randomized controlled trial. Surg Endosc. 2011;25:1814–21.

    PubMed  Article  Google Scholar 

  35. van Hooft JE, Bemelman WA, Oldenburg B, Marinelli AW, Lutke Holzik MF, et al. Colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a multicentre randomised trial. Lancet Oncol. 2011;12:344–52.

    PubMed  Article  Google Scholar 

  36. Lundy J, Ford CM. Surgery, trauma and immune suppression. Evolving the mechanism. Ann Surg. 1983;197:434–8.

    CAS  Article  Google Scholar 

  37. Matsuda A, Furukawa K, Suzuki H, Kan H, Tsuruta H, Matsumoto S, et al. Does impaired TH1/TH2 balance cause postoperative infectious complications in colorectal cancer surgery? J Surg Res. 2007;139:15–21.

    CAS  PubMed  Article  Google Scholar 

  38. Matsuda A, Matsutani T, Sasajima K, Furukawa K, Tajiri T, Tamura K, et al. Preoperative plasma adiponectin level is a risk factor for postoperative infection following colorectal cancer surgery. J Surg Res. 2009;157:227–34.

    CAS  PubMed  Article  Google Scholar 

  39. Matsuda A, Matsumoto S, Seya T, Matsutani T, Kishi T, Yokoi K, et al. Does postoperative complication have a negative impact on long-term outcomes following hepatic resection for colorectal liver metastasis?: a meta-analysis. Ann Surg Oncol. 2013;20:2485–92.

    PubMed  Article  Google Scholar 

  40. Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg. 2011;253:890–9.

    PubMed  Article  Google Scholar 

  41. Platt JJ, Ramanathan ML, Crosbie RA, Anderson JH, McKee RF, Horgan PG, et al. C-reactive protein as a predictor of postoperative infective complications after curative resection in patients with colorectal cancer. Ann Surg Oncol. 2012;19:4168–77.

    PubMed  Article  Google Scholar 

  42. Biagi JJ, Raphael MJ, Mackillop WJ, Kong W, King WD, Booth CM. Association between time to initiation of adjuvant chemotherapy and survival in colorectal cancer: a systematic review and meta-analysis. JAMA. 2011;305:2335–42.

    CAS  PubMed  Article  Google Scholar 

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Acknowledgment

The authors thank the surgical staff at the Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital for acquisition of data.

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Affiliations

  1. Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan

    Akihisa Matsuda MD, Masao Miyashita MD, Satoshi Matsumoto MD, Nobuyuki Sakurazawa MD & Goro Takahashi MD

  2. Department of Gastroenterological Surgery, Nippon Medical School, Tokyo, Japan

    Takeshi Matsutani MD & Eiji Uchida MD

  3. Department of Psychiatry, Fujita Health University School of Medicine, Aichi, Japan

    Taro Kishi MD

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  1. Akihisa Matsuda MD
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  2. Masao Miyashita MD
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  3. Satoshi Matsumoto MD
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  5. Nobuyuki Sakurazawa MD
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Correspondence to Akihisa Matsuda MD.

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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 22, 497–504 (2015). https://doi.org/10.1245/s10434-014-3997-7

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  • DOI: https://doi.org/10.1245/s10434-014-3997-7

Keywords

  • Overall Survival
  • Risk Ratio
  • Oncological Outcome
  • Stoma Creation
  • Overall Survival Analysis