Short-term and Three-year Long-term Outcomes of Laparoscopic Surgery Versus Open Surgery for Obstructive Colorectal Cancer Following Self-expandable Metallic Stent Placement: a Meta-analysis

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2024 Aug 29

PMID 39210057

Authors

Shintaro Kanaka

Takeshi Yamada

Akihisa Matsuda

Kay Uehara

Seiichi Shinji

Yasuyuki Yokoyama

Goro Takahashi

Takuma Iwai

Kohki Takeda

Sho Kuriyama

Toshimitsu Miyasaka

Hiroshi Yoshida

Affiliations

Soon will be listed here.

Abstract

Background: A bridge to surgery (BTS) after self-expandable metallic stent (SEMS) placement is a widely recognized treatment strategy for obstructive colorectal cancer. However, there is still a lack of evidence for the efficacy and safety of laparoscopic surgery following SEMS placement. The aim of this systematic review and meta-analysis was to compare the short-term and long-term outcomes of laparoscopic surgery with those of open surgery following SEMS placement in patients with obstructive colorectal cancer.

Methods: An electronic literature search through to December 2022 was performed to identify studies comparing short-term and long-term outcomes between laparoscopic and open surgery following SEMS placement for obstructive colorectal cancer. The main outcome measures were postoperative complication rates and mortality. Secondary outcome measures were the 3-year recurrence-free survival (RFS) and 3-year overall survival (OS) rates. The meta-analysis was performed using fixed-effect or random-effects methods to calculate odds ratios (ORs) with 95% confidence intervals (95% CIs).

Results: The meta-analysis included 15 studies and 883 patients, of whom 467 (52.9%) underwent laparoscopic surgery and 416 (47.1%) underwent open surgery following SEMS placement. The postoperative complication rate was significantly lower in the laparoscopic surgery group than in the open surgery group (OR 0.47, 95% CI 0.32-0.67, P < 0.001). There was no significant difference in the 3-year RFS rate or 3-year OS rate between the laparoscopic and open surgery groups (3-year RFS, OR 0.78, 95% CI 0.50-1.24, P = 0.30; 3-year OS, OR 0.68, 95% CI 0.41-1.12, P = 0.13).

Conclusion: This meta-analysis found that the short-term outcome was better in patients who underwent laparoscopic surgery following SEMS placement than in those who underwent open surgery. Furthermore, there was no significant difference in long-term outcomes between the two groups. Laparoscopic surgery following SEMS placement may be a safe and effective treatment option for obstructive colorectal cancer.

References

Carraro P, Segala M, Cesana B, Tiberio G . Obstructing colonic cancer: failure and survival patterns over a ten-year follow-up after one-stage curative surgery. Dis Colon Rectum. 2001; 44(2):243-50. DOI: 10.1007/BF02234300. View

Manceau G, Voron T, Mege D, Bridoux V, Lakkis Z, Venara A . Prognostic factors and patterns of recurrence after emergency management for obstructing colon cancer: multivariate analysis from a series of 2120 patients. Langenbecks Arch Surg. 2019; 404(6):717-729. DOI: 10.1007/s00423-019-01819-5. View

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(10 Suppl):S44-9. DOI: 10.1097/01.DCR.0000087483.63718.A2. View

Amelung F, Draaisma W, Consten E, Siersema P, Borg F . Self-expandable metal stent placement versus emergency resection for malignant proximal colon obstructions. Surg Endosc. 2017; 31(11):4532-4541. DOI: 10.1007/s00464-017-5512-2. View

Dohmoto M, Rupp K, Hohlbach G . [Endoscopically-implanted prosthesis in rectal carcinoma]. Dtsch Med Wochenschr. 1990; 115(23):915. 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

Matsuda A, Miyashita M, Matsumoto S, Matsutani T, Sakurazawa N, Takahashi G . 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. 2014; 22(2):497-504. DOI: 10.1245/s10434-014-3997-7. View

Allievi N, Ceresoli M, Fugazzola P, Montori G, Coccolini F, Ansaloni L . Endoscopic Stenting as Bridge to Surgery versus Emergency Resection for Left-Sided Malignant Colorectal Obstruction: An Updated Meta-Analysis. Int J Surg Oncol. 2017; 2017:2863272. PMC: 5516723. DOI: 10.1155/2017/2863272. View

Erichsen R, Horvath-Puho E, Jacobsen J, Nilsson T, Baron J, Sorensen H . Long-term mortality and recurrence after colorectal cancer surgery with preoperative stenting: a Danish nationwide cohort study. Endoscopy. 2015; 47(6):517-24. DOI: 10.1055/s-0034-1391333. View

10.

Cwikiel W, Andren-Sandberg A . Malignant stricture with colovesical fistula: stent insertion in the colon. Radiology. 1993; 186(2):563-4. DOI: 10.1148/radiology.186.2.8421765. View

11.

Kye B, Kim J, Kim H, Lee Y, Lee I, Kang W . The optimal time interval between the placement of self-expandable metallic stent and elective surgery in patients with obstructive colon cancer. Sci Rep. 2020; 10(1):9502. PMC: 7289825. DOI: 10.1038/s41598-020-66508-6. View

12.

Morino M, Bertello A, Garbarini A, Rozzio G, Repici A . Malignant colonic obstruction managed by endoscopic stent decompression followed by laparoscopic resections. Surg Endosc. 2002; 16(10):1483-7. DOI: 10.1007/s00464-001-9182-7. View

13.

van Hooft J, Veld J, Arnold D, Beets-Tan R, Everett S, Gotz M . Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2020. Endoscopy. 2020; 52(5):389-407. DOI: 10.1055/a-1140-3017. View

14.

Lacy A, Garcia-Valdecasas J, Delgado S, Castells A, Taura P, Pique J . Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet. 2002; 359(9325):2224-9. DOI: 10.1016/S0140-6736(02)09290-5. View

15.

Leung K, Kwok S, Lam S, Lee J, Yiu R, Ng S . Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet. 2004; 363(9416):1187-92. DOI: 10.1016/S0140-6736(04)15947-3. View

16.

Weeks J, Nelson H, Gelber S, Sargent D, Schroeder G . Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial. JAMA. 2002; 287(3):321-8. DOI: 10.1001/jama.287.3.321. View

17.

Kitano S, Inomata M, Sato A, Yoshimura K, Moriya Y . Randomized controlled trial to evaluate laparoscopic surgery for colorectal cancer: Japan Clinical Oncology Group Study JCOG 0404. Jpn J Clin Oncol. 2005; 35(8):475-7. DOI: 10.1093/jjco/hyi124. View

18.

Balague C, Targarona E, Sainz S, Montero O, Bendahat G, Kobus C . Minimally invasive treatment for obstructive tumors of the left colon: endoluminal self-expanding metal stent and laparoscopic colectomy. Preliminary results. Dig Surg. 2004; 21(4):282-6. DOI: 10.1159/000080202. View

19.

Olmi S, Scaini A, Cesana G, Dinelli M, Lomazzi A, Croce E . Acute colonic obstruction: endoscopic stenting and laparoscopic resection. Surg Endosc. 2007; 21(11):2100-4. DOI: 10.1007/s00464-007-9352-3. View

20.

Stipa F, Pigazzi A, Bascone B, Cimitan A, Villotti G, Burza A . Management of obstructive colorectal cancer with endoscopic stenting followed by single-stage surgery: open or laparoscopic resection?. Surg Endosc. 2007; 22(6):1477-81. DOI: 10.1007/s00464-007-9654-5. View