Skip to main content
SpringerLink
Log in

Colonic stent as a bridge to surgery versus emergency resection for right-sided malignant large bowel obstruction: a meta-analysis

  • Review Article
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Preoperative colonic stenting for malignant large bowel obstruction (MLBO), also called bridge to surgery (BTS), is considered a great substitute treatment for emergency resection (ER) in the left-sided colon. However, its efficacy in the right-sided colon remains controversial. This systematic review and meta-analysis aimed to compare the postoperative short-term outcomes between BTS and ER for right-sided MLBO.

Methods

A comprehensive electronic literature search throughout December 2020 was performed to identify studies comparing short-term outcomes between BTS and ER for right-side MLBO. The main outcome measures were postoperative complications and mortality rates. A meta-analysis was performed using a fixed-effect or a random-effect method to calculate odds ratios (ORs) with 95% confidence intervals (95% CIs).

Results

Seven studies were included in this meta-analysis, comprising 5136 patients, of whom 1662 (32.4%) underwent BTS and 3474 (67.6%) underwent ER. This meta-analysis demonstrated that BTS resulted in reductions in postoperative complications (OR = 0.78; 95% CI: 0.66–0.92) and mortality (OR = 0.51; 95% CI: 0.28–0.92) than ER.

Conclusion

The results of this meta-analysis indicate that BTS for right-sided MLBO confers preferable short-term outcomes as well as for left-sided. This suggests that BTS results in a reduction of postoperative complications and mortality for right-sided MLBO than ER.

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
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Carraro PGS, Segala M, Cesana BM, Tiberio G (2001) Obstructing colonic cancer: failure and survival patterns over a 10 year follow up after one stage curative surgery. Dis Colon Rectum 44:243–250

    Article  CAS  Google Scholar 

  2. De Salvo GL, Gava C, Pucciarelli M. Curative surgery for obstruction from primary left colorectal carcinoma: primary or staged resection? (2004) Cochran Database of Syst Rev. DOI: https://doi.org/10.1002/14651858.CD002101.pub2, April 19, 2004

  3. Manceau G, Voron T, Mege D, Bridoux V, Lakkis Z, Venara A, Beyer-Berjot L, Abdalla S, Sielezneff I, Lefèvre JH, Karoui M; AFC (French Surgical Association) Working Group (2019). Prognostic factors and patterns of recurrence after emergency management for obstructing colon cancer: multivariate analysis from a series of 2120 patients. Langenbecks Arch Surg; 404: 717–729

  4. Saida Y, Sumiyama Y, Nagao J, Uramatsu M (2003) Long-term prognosis of preoperative “bridge to surgery” expandable metallic stent insertion for obstructive colorectal cancer: comparison with emergency operation. Dis Colon Rectum 46(10 Suppl):S44–S49

    PubMed  Google Scholar 

  5. Amelung FJ, Draaisma A, Consten ECJ, Siersema PD, ter Borg F (2017) Self-expandable metal stent placement versus emergency resection for malignant proximal colon obstructions. Surg Endosc 31:4532–4541

    Article  Google Scholar 

  6. Tanis PJ, Paulino PNR, van Hooft JE, Consten ECJ, Bemelman WA (2015) Resection of obstructive left-sided colon cancer at a national level: a prospective analysis of short-term outcomes in 1,816 patients. Dig Surg 32:317–324

    Article  Google Scholar 

  7. Öistämö E, Hjern F, Blomqvist L, Falkén Y, Pekkari K, Abraham-Nordling M (2016) Emergency management with resection versus proximal stoma or stent treatment and planned resection in malignant left-sided colon obstruction. World J Surg Oncol 14:1–7

    Article  Google Scholar 

  8. van Hooft JE, Veld JV, Arnold D, Beets-Tan RGH, Everett S, GötzM, van Halsema EE, Hill J, Manes G, Meisner S, Rodrigues-Pinto E, Sabbagh C, Vandervoort J, Tanis PJ, Vanbiervliet G, Arezzo A (2020). Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline–Update 2020. Endoscopy. 52: 389–407

  9. Yang SY, Park YY, Han YD, Cho MS, Hur H, Min BS, Lee KY, Kim NK (2019) 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 26:2787–2796

    Article  Google Scholar 

  10. Matsuda A, Miyashita M, Matsumoto S, Matsutani T, Sakurazawa N, Takahashi G, Kishi T, Uchida E (2015) 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

    Article  Google Scholar 

  11. Huang X, Lv B, Zhang S, Meng L (2014) Preoperative colonic stents versus emergency surgery for acute left-sided malignant colonic obstruction: a meta-analysis. J Gastrointest Surg 18:584–591

    Article  Google Scholar 

  12. Allievi N, Ceresoli M, Fugazzola P, Montori G, Coccolini F, Ansaloni L (2017) Endoscopic stenting as bridge to surgery versus emergency resection for left-sided malignant colorectal obstruction: an updated meta-analysis. Int J Surg Oncol. https://doi.org/10.1155/2017/2863272,Jul5,2017

    Article  PubMed  PubMed Central  Google Scholar 

  13. Lee YM, Law WL, Chu KW, Poon RTP (2011) Emergency surgery for obstructing colorectal cancers: a comparison between right-sided and left-sided lesions. J Am Coll Surg 192:719–725

    Article  Google Scholar 

  14. Smithers BM, Theile DE, Cohen JR, Evans EB, Davis NC (1986) Emergency right hemicolectomy in colon carcinoma: a prospective study. Aust N Z J Surg 56:749–752

    Article  CAS  Google Scholar 

  15. Goligher JC, Smiddy FG (1957) The treatment of acute obstruction or perforation with carcinoma of the colon and rectum. Br J Surg 45:270–274

    Article  CAS  Google Scholar 

  16. Smothers L, Hynan L, Fleming J, Turnage R, Simmang C, Anthony T (2003) Emergency surgery for colon carcinoma. Dis Colon Rectum 46:24–30

    Article  Google Scholar 

  17. Kobayashi H, Miyata H, Gotoh M, BabaH KW, Kitagawa Y, Nakagoe T, Shimada M, Tomita N, Sugihara K, Mori M (2014) Risk model for right hemicolectomy based on 19,070 Japanese patients in the National Clinical Database. J Gastroenterol 49:1047–1055

    Article  Google Scholar 

  18. Matsuda A, Yamada M, Matsumoto S, Sakurazawa N, Kawano Y, Sekiguchi K, Yamada T, Matsutani T, Miyashita M, Yoshida H (2019) Blood galectin-3 levels predict postoperative complications after colorectal cancer surgeries. J Nippon Med Sch 86(3):142–148

    Article  Google Scholar 

  19. Amelung FJ, de Beaufort HWL, Siersema PD, Verheijen PM, Consten ECJ (2015) Emergency resection versus bridge to surgery with stenting in patients with acute right-sided colonic obstruction: a systematic review focusing on mortality and morbidity rates. Int Colorectal Dis 30:1147–1155

    Article  CAS  Google Scholar 

  20. van den Berg MW, Sloothaak DAM, Dijkgraaf MGW, van der Zaag ES, Bemelman WA, Tanis PJ, Bosker RJI, Fockens P, ter Borg F, van Hooft JE (2014) Bridge-to-surgery stent placement versus emergency surgery for acute malignant colonic obstruction. Br J Surg 101:867–873

    Article  Google Scholar 

  21. Ji WB, Kwak JM, Kang DW, Kwak HD, Um JW, Lee SI, Min BW, Sung NS, Kim J, Kim SH (2017) Clinical benefits and oncologic equivalence of self-expandable metallic stent insertion for right-sided malignant colonic obstruction. Surg Endosc 31:153–158

    Article  Google Scholar 

  22. Amelung FJ, Consten ECJ, Siersema PD, Tanis PJ (2016) A population-based analysis of three treatment modalities for malignant obstruction of the proximal colon: acute resection versus stent or stoma as a bridge to surgery. Ann Surg Oncol 23:3660–3668

    Article  CAS  Google Scholar 

  23. Kye BH, Lee YS, Cho HM, Kim JG, Oh ST, Lee IK, Kang WK, Ahn CH, Lee SC, Park JK, Kim HJ (2016) Comparison of long-term outcomes between emergency surgery and bridge to surgery for malignant obstruction in right-sided colon cancer: a multicenter retrospective study. Ann Surg Oncol 23:1867–1874

    Article  Google Scholar 

  24. Morita S, Yamamoto K, Ogawa A, Naito A, Mizuno H, Yoshioka S, Matsumura T, Ohta , Suzuki R, Matsuda C, Hata T, Nishimura J, Mizushima T, Doki Y, Mori M, Clinical Study Group of Osaka University (CSGO), Colorectal Group (2019). Benefits of using a self-expandable metallic stent as a bridge to surgery for right-and left-sided obstructive colorectal cancers. Surg Today. 49: 32–7

  25. Sakamoto T, Fujiogi M, Lefor AK, Matsui H, Fushimi K, Yasunaga H (2020) Stent as a bridge to surgery or immediate colectomy for malignant right colonic obstruction: propensity-scored, national database study. Br J Surg 107:1354–1362

    Article  CAS  Google Scholar 

  26. Li B, Cai SL, Lv ZT, Zhou PH, Yao LQ, Shi Q, Qi ZP, Sun D, Yalikong A, Xu EP, Xu JM, Zhong YS (2020) Self-expandable metallic stenting as a bridge to elective surgery versus emergency surgery for acute malignant right-sided colorectal obstruction. BMC Surg 20:1–10

    Article  CAS  Google Scholar 

  27. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D (2021). The PRISMA statement: an updated guideline for reporting systematic reviews. BMJ. 29;372:n71.

  28. Slim K, Nini E, Forest D, Kwiatkowsi F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73:712–716

    Article  Google Scholar 

  29. Balshem H, Helfand M, Schünemann HJ et al (2011) GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol 64:401–406

    Article  Google Scholar 

  30. Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560

    Article  Google Scholar 

  31. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

    Article  CAS  Google Scholar 

  32. Egger M, Smith GD, Schneider M, Minderet C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634

    Article  CAS  Google Scholar 

  33. Abramson JH (2011) WINPEPI updated: computer programs for epidemiologists, and their teaching potential. Epidemiol Perspect Innov 8:1–9

    Article  Google Scholar 

  34. Runkel NS, Schlag P, Schwarz V, Herfarth C (1991) Outcome after emergency surgery for cancer of the large intestine. Br J Surg 78:183–188

    Article  CAS  Google Scholar 

  35. Dohmoto M, Rupp KD, Hohlbach G (1990) Endoscopicallyimplanted prosthesis in rectal carcinoma. Dtsch Med Wochenschr 115:915

    CAS  PubMed  Google Scholar 

  36. Cwikiel W, Andren-Sandberg A (1993) Malignant stricture with colovesical fistula: stent insertion in the colon. Radiology 186:563–564

    Article  CAS  Google Scholar 

  37. Gregorio MA, Mainar A, Rodriguez J, Alfonso ER, Tejero E, Herrera M, Medrano J, D’Agostino H (2004) Colon stenting: a review. Semin Intervent Radiol 21:205–216

    Article  Google Scholar 

  38. Gianotti L, Tamini N, Nespoli L, Rota M, Bolzonaro E, Frego R, Redaelli A, Antolini L, Ardito A, Nespoli A, Dinelli M (2013) 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 27:832–842

    Article  Google Scholar 

  39. Weiss JM, Pfau PR, O’Connor ES, King J, LoConte N, Kennedy G, Smith MA (2011) Mortality by stage for right-versus left-sided colon cancer: analysis of surveillance, epidemiology, and end results–Medicare data. J Clin Oncol 29:4401

    Article  Google Scholar 

  40. Lee YM, Lau WM, Chu KW, Poon RT (2001) Emergency surgery for obstructing colorectal cancers: a comparison between right-sided and left-sided lesions. J Am Coll Surg 192:719–725

    Article  CAS  Google Scholar 

  41. Hsu TC (2005) Comparison of one-stage resection and anastomosis of acute complete obstruction of left and right colon. Am J Surg 189:384–387

    Article  Google Scholar 

  42. Campbell KL, Hussey JK, Eremin O (1997) Expandable metal stent application in obstructing carcinoma of the proximal colon: report of a case. Dis Colon Rectum 40:1391–1393

    Article  CAS  Google Scholar 

  43. Cho YK, Kim SW, Lee BI, Lee KM, Lim CH, Kim JS, Chang JH, Park JM, Lee IS, Choi MG, Choi KY, Chung IS (2011) Clinical outcome of self-expandable metal stent placement in the management of malignant proximal colon obstruction. Gut Liver 5:165–170

    Article  Google Scholar 

  44. Kuwai T, Yamaguchi T, Imagawa H, Yoshida S, Isayama H, Matsuzawa T, Yamada T, Saito S, Shimada M, Hirata N, Sasaki T, Koizumi K, Maetani I, Saida Y (2019) Factors related to difficult self-expandable metallic stent placement for malignant colonic obstruction: A post-hoc analysis of a multicenter study across Japan. Gastrointest Endosc 31:51–58

    Google Scholar 

Download references

Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

Funding

None.

Author information

Authors and Affiliations

  1. Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan

    Shintaro Kanaka, Akihisa Matsuda, Takeshi Yamada, Ryo Ohta, Hiromichi Sonoda, Seiichi Shinji, Goro Takahashi, Takuma Iwai, Kohki Takeda, Koji Ueda, Sho Kuriyama, Toshimitsu Miyasaka & Hiroshi Yoshida

Authors
  1. Shintaro Kanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Akihisa Matsuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Takeshi Yamada
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ryo Ohta
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hiromichi Sonoda
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Seiichi Shinji
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Goro Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Takuma Iwai
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kohki Takeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Koji Ueda
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Sho Kuriyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Toshimitsu Miyasaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Hiroshi Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study concept and design: SK, AM, TY, RO, SS, GT, TI, and KT. Literature search and data collection: SK and AM. Statistical analysis and interpretation of data: SK, AM, KU, SK, and TM. Drafting of manuscript: SK and AM. Revising the manuscript: HS and TY. Study supervision: TY and HY. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Akihisa Matsuda.

Ethics declarations

Disclosures

Drs. Shintaro Kanaka, Akihisa Matsuda, Takeshi Yamada, Ryo Ohta, Hiromichi Sonoda, Seiichi Shinji, Goro Takahashi, Takuma Iwai, Kohki Takeda, Koji Ueda, Sho Kuriyama, Toshimitsu Miyasaka, and Hiroshi Yoshida have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

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

Supplementary Information

Below is the link to the electronic supplementary material.

464_2022_9071_MOESM1_ESM.tif

Supplementary file1—Supplementary Figure 1. Meta-analysis of primary anastomosis between bridge to surgery and emergency resection. Odds ratio is shown with 95% confidence intervals. ER: emergency surgery; BTS: Bridge to surgery. (TIF 144 kb)

464_2022_9071_MOESM2_ESM.tif

Supplementary file2—Supplementary Figure 2. Meta-analysis of stoma construction between bridge to surgery and emergency resection. Odds ratio is shown with 95% confidence intervals. ER: emergency surgery; BTS: Bridge to surgery. (TIF 146 kb)

464_2022_9071_MOESM3_ESM.tif

Supplementary file3—Supplementary Figure 3. Meta-analysis of laparoscopic surgery between bridge to surgery and emergency resection. Odds ratio is shown with 95% confidence intervals. ER: emergency surgery; BTS: Bridge to surgery. (TIF 156 kb)

464_2022_9071_MOESM4_ESM.tif

Supplementary file4—Supplementary Figure 4. Meta-analysis of anastomotic leakage between bridge to surgery and emergency resection. Odds ratio is shown with 95% confidence intervals. ER: emergency surgery; BTS: Bridge to surgery. (TIF 146 kb)

464_2022_9071_MOESM5_ESM.tif

Supplementary file5—Supplementary Figure 5. Meta-analysis of surgical site infection between bridge to surgery and emergency resection. Odds ratio is shown with 95% confidence intervals. ER: emergency surgery; BTS: Bridge to surgery. (TIF 146 kb)

464_2022_9071_MOESM6_ESM.tif

Supplementary file6—Supplementary Figure 6. Meta-analysis of ileus between bridge to surgery and emergency resection. Odds ratio is shown with 95% confidence intervals. ER: emergency surgery; BTS: Bridge to surgery. (TIF 144 kb)

Supplementary file7 (DOCX 18 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kanaka, S., Matsuda, A., Yamada, T. et al. Colonic stent as a bridge to surgery versus emergency resection for right-sided malignant large bowel obstruction: a meta-analysis. Surg Endosc 36, 2760–2770 (2022). https://doi.org/10.1007/s00464-022-09071-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-022-09071-7

Keywords

Search

Navigation