Long-term Survival Analysis After Endoscopic Stenting As a Bridge to Surgery for Malignant Colorectal Obstruction: Comparison with Emergency Diverting Colostomy

Overview

Journal Clinics (Sao Paulo)

Publisher Elsevier

Specialty General Medicine

Date 2020 Nov 18

PMID 33206763

Authors

Rodrigo Corsato Scomparin

Bruno Costa Martins

Luciano Lenz

Luiza Haendchen Bento

Carlos Sparapam Marques

Adriana Safatle-Ribeiro

Ulysses Ribeiro Jr

Sergio Carlos Nahas

Fauze Maluf-Filho

Affiliations

Soon will be listed here.

Abstract

Objective: The use of colorectal self-expanding metal stents (SEMS) as bridge therapy for malignant colorectal obstruction was first reported more than 20 years ago. However, its use remains controversial. In this study, we aimed to compare the long-term survival of patients with potentially resectable malignant colorectal obstruction who had undergone colorectal SEMS placement and emergency surgery.

Methods: This study was a retrospective analyses. Patients who received treatment between 2009 and 2017 were included. According to the eligibility criteria, 21 patients were included in the SEMS group and 67 patients were included in the surgical group..

Results: The majority of the patients in the SEMS group were female (57.1%), whereas the majority of those in the surgical group were male (53.7%). The median follow-up time was 60 months for both groups with the same interquartile range of 60 months. There was no difference in the overall survival rate (log rank p=0.873) and disease-free survival rate (log rank p=0.2821) in the five-year analysis. There was no difference in local recurrence rates (38.1% vs. 22.4%, p=0.14) or distant recurrence rates (33.3% vs. 50.7%, p=0.16) in the SEMS and the surgical groups. Technical and clinical success rates of endoscopic stenting were 95.3% and 85.7%, respectively. There were no immediate adverse events (AEs). Severe AEs included perforation (14.3%), silent perforation (4.7%), reobstruction (14.3%), and bleeding (14.3%). Mild AEs included pain (42.8%), tenesmus (9.5%), and incontinence (4.76%). The limitations of this study was retrospective and was conducted at a single center.

Conclusions: No differences in disease-free and overall survival rates were observed in the five-year analysis of patients with resectable colorectal cancer who had undergone SEMS placement or colostomy for the treatment of malignant colorectal obstruction. Patients in the SEMS group had a higher rate of primary anastomosis and a lower rate of temporary colostomy than did those in the surgery group.

References

van Hooft J, Bemelman W, Oldenburg B, Marinelli A, Lutke Holzik M, Grubben M . Colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a multicentre randomised trial. Lancet Oncol. 2011; 12(4):344-52. DOI: 10.1016/S1470-2045(11)70035-3. View

Sagar J . Colorectal stents for the management of malignant colonic obstructions. Cochrane Database Syst Rev. 2011; (11):CD007378. PMC: 6885054. DOI: 10.1002/14651858.CD007378.pub2. View

Ceresoli M, Allievi N, Coccolini F, Montori G, Fugazzola P, Pisano M . Long-term oncologic outcomes of stent as a bridge to surgery versus emergency surgery in malignant left side colonic obstructions: a meta-analysis. J Gastrointest Oncol. 2017; 8(5):867-876. PMC: 5674262. DOI: 10.21037/jgo.2017.09.04. View

Ribeiro I, Pinho R, Leite M, Proenca L, Silva J, Ponte A . Reevaluation of Self-Expanding Metal Stents as a Bridge to Surgery for Acute Left-Sided Malignant Colonic Obstruction: Six Years Experience. GE Port J Gastroenterol. 2017; 23(2):76-83. PMC: 5580145. DOI: 10.1016/j.jpge.2016.01.003. View

Arezzo A, Lo Secco G, Passera R, Morino M . Response. Gastrointest Endosc. 2019; 90(4):705-706. DOI: 10.1016/j.gie.2019.06.021. View

Lara-Romero C, Vilches A, Caunedo-Alvarez A, Hergueta-Delgado P, Lavin-Castejon I, Andrade-Bellido R . Better recurrence-free survival after stent bridge to surgery compared to emergency surgery for obstructive left-sided colonic cancer in patients with stage III status of the American Joint Committee on Cancer (AJCC): a bicentric retrospective study. Int J Colorectal Dis. 2019; 34(7):1241-1250. DOI: 10.1007/s00384-019-03318-x. View

Kuipers E, Grady W, Lieberman D, Seufferlein T, Sung J, Boelens P . Colorectal cancer. Nat Rev Dis Primers. 2016; 1:15065. PMC: 4874655. DOI: 10.1038/nrdp.2015.65. View

Deans G, Krukowski Z, Irwin S . Malignant obstruction of the left colon. Br J Surg. 1994; 81(9):1270-6. DOI: 10.1002/bjs.1800810905. View

Yang S, Park Y, Han Y, Cho M, Hur H, Min B . 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(9):2787-2796. DOI: 10.1245/s10434-019-07346-3. View

10.

Arezzo A, Passera R, Lo Secco G, Verra M, Bonino M, Targarona E . 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(3):416-426. DOI: 10.1016/j.gie.2017.03.1542. View

11.

De Ceglie A, Filiberti R, Baron T, Ceppi M, Conio M . 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(2):387-403. DOI: 10.1016/j.critrevonc.2013.06.006. View

12.

Scott N, Jeacock J, Kingston R . Risk factors in patients presenting as an emergency with colorectal cancer. Br J Surg. 1995; 82(3):321-3. DOI: 10.1002/bjs.1800820311. View

13.

Verstockt B, Van Driessche A, De Man M, van der Spek P, Hendrickx K, Casneuf V . Ten-year survival after endoscopic stent placement as a bridge to surgery in obstructing colon cancer. Gastrointest Endosc. 2017; 87(3):705-713.e2. DOI: 10.1016/j.gie.2017.05.032. View

14.

Khot U, Wenk Lang A, Murali K, Parker M . Systematic review of the efficacy and safety of colorectal stents. Br J Surg. 2002; 89(9):1096-102. DOI: 10.1046/j.1365-2168.2002.02148.x. View

15.

Gorissen K, Tuynman J, Fryer E, Wang L, Uberoi R, Jones O . Local recurrence after stenting for obstructing left-sided colonic cancer. Br J Surg. 2013; 100(13):1805-9. DOI: 10.1002/bjs.9297. View

16.

Sebastian S, Johnston S, Geoghegan T, Torreggiani W, Buckley M . Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol. 2004; 99(10):2051-7. DOI: 10.1111/j.1572-0241.2004.40017.x. View

17.

Sabbagh C, Browet F, Diouf M, Cosse C, Brehant O, Bartoli E . 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(1):107-15. DOI: 10.1097/SLA.0b013e31827e30ce. View

18.

Maruthachalam K, Lash G, Shenton B, Horgan A . Tumour cell dissemination following endoscopic stent insertion. Br J Surg. 2007; 94(9):1151-4. DOI: 10.1002/bjs.5790. View

19.

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(8):1904-10. DOI: 10.1007/s00268-011-1139-y. View

20.

Cotton P, Eisen G, Aabakken L, Baron T, Hutter M, Jacobson B . A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc. 2010; 71(3):446-54. DOI: 10.1016/j.gie.2009.10.027. View