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Self-expandable metallic stent as bridge to surgery vs. emergency resection in obstructive right-sided colon cancer: a systematic review and meta-analysis

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Abstract

Background

Emergency resection is common for malignant right-sided obstructive colon cancer. As there is evidence showing a potential benefit of self-expandable metal stents as a bridge to surgery, a new debate has been initiated.

Objective

The aim of this study was to compare self-expandable metal stents with emergency resection in right-sided obstructive colon cancer.

Data source

A systematic search was conducted accessing Medline/PubMed, Scopus, Embase, and the Cochrane Database of Systematic Reviews.

Study selection

Studies reporting either emergency surgery or stent placement in right-sided obstructive colon cancer were included.

Intervention

Stent or emergency resection in right-sided obstructive colon cancer.

Main outcome measures

Morbidity rate, mortality rate, stoma rate, laparoscopic resection rate, anastomotic insufficiency rate, success rate of stent.

Results

A total of 6343 patients from 16 publications were analyzed. The stent success rate was 0.92 (95% CI, 0.87 to 0.95) with perforation of 0.03 (95% CI, 0.01 to 0.06). Emergency resection was performed laparoscopically at a rate of 0.15 (95% CI, 0.09 to 0.24). Primary anastomosis rate in emergency resection was 0.95 (95% CI, 0.91 to 0.97) with an anastomotic insufficiency rate of 0.07 (95% CI, 0.04 to 0.11). The mortality rate after emergency resection was 0.05 (95% CI, 0.02 to 0.09). Primary anastomosis and anastomotic insufficiency rate were similar between the two groups (RR: 1.02; 95% CI, 0.95 to 1.1; p = 0.56 and RR: 0.53; 95% CI, 0.14 to 1.93; p = 0.33). The mortality rate in emergency resection was higher compared to stent (RR: 0.51, 95% CI 0.30 to 10.89, p = 0.016).

Limitation

No randomized controlled trials are available.

Conclusion

Stent is a safe and successful alternative to emergency resection and may increase the rate of minimally invasive surgery. Emergency resection, however, remains safe and did not result in higher rate of anastomotic insufficiency. Further high-quality comparative studies are warranted to assess long-term outcomes.

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Data Availability

The source data are availabe by corresponding author upon reasonable request.

Abbreviations

CRC:

Colorectal cancer

BTS:

Bridge to surgery

ER:

Emergency resection

ROCC:

Right-sided obstructive colon cancer

SEMS:

Self-expandable metal stents

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Funding

This study was funded by Hospital Muri.

The authors declare no competing interests.

Author information

Authors and Affiliations

  1. Department of General Surgery, Hospital Muri, Muri, Switzerland

    Mirjam Mäder, Fabian Kalt, Markus von der Groeben, Allan Novak, Gerfried Teufelberger, Kuno Lehmann & Dilmurodjon Eshmuminov

  2. Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland

    Fabian Kalt, Marcel Schneider, Philipp Kron & Michaela Ramser

  3. Department of Surgery and Transplantation, IMIB-Arrixaca, Virgen de La Arrixaca Clinic and University, Murcia, Spain

    Victor Lopez-Lopez

  4. Department of General and Digestive Surgery, Bellvitge University Hospital, Barcelona, Spain

    Sebastiano Biondo

  5. Department of Surgery, Grenoble Alps University Hospital, Grenoble, France

    Jean-Luc Faucheron

  6. Department of Surgery, Ashikaga Red Cross Hospital, Tochigi, Japan

    Suzuki Yoshiyuki

  7. Department of Surgery and Transplantation, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland

    Dilmurodjon Eshmuminov

Authors
  1. Mirjam Mäder
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Contributions

M. M. and F. K. share first authorship. M. M., F. K., and E. D. wrote the main manuscript text. E. D. performed the statistical analysis. All authors critically reviewed the manuscript and approved it for publication.

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Correspondence to Dilmurodjon Eshmuminov.

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M. M. and F. K. share first authorship.

K. L. and D. E. share last authorship.

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Mäder, M., Kalt, F., Schneider, M. et al. Self-expandable metallic stent as bridge to surgery vs. emergency resection in obstructive right-sided colon cancer: a systematic review and meta-analysis. Langenbecks Arch Surg 408, 265 (2023). https://doi.org/10.1007/s00423-023-02979-1

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