scholarly journals Long-term oncologic outcomes of stent as a bridge to surgery versus emergency surgery in malignant left side colonic obstructions: a meta-analysis

2017 ◽  
Vol 8 (5) ◽  
pp. 867-876 ◽  
Author(s):  
Marco Ceresoli ◽  
Niccolò Allievi ◽  
Federico Coccolini ◽  
Giulia Montori ◽  
Paola Fugazzola ◽  
...  
Keyword(s):  
Emergency Surgery ◽  
Meta Analysis ◽  
Oncologic Outcomes ◽  
Bridge To Surgery

scholarly journals Comparison of safety between self-expanding metal stents as a bridge to surgery and emergency surgery based on pathology: a meta-analysis

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yang Hu ◽  
Jiajun Fan ◽  
Yifan Xv ◽  
Yingjie Hu ◽  
Yuan Ding ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Emergency Surgery ◽  
Meta Analysis ◽  
Metal Stents ◽  
Bridge To Surgery ◽  
Sems Group ◽  
Obstructive Colorectal Cancer ◽  
Significant Difference ◽  
Self Expanding Metal Stents

Abstract Background To explore the long-term oncological safety of using self-expanding metal stents (SEMS) as a bridge to surgery for acute obstructive colorectal cancer by comparing the pathological results of emergency surgery (ES) with elective surgery after the placement of SEMS. Methods Studies comparing SEMS as a bridge to surgery with emergency surgery for acute obstructive colorectal cancer were retrieved through the databases of Pubmed, Embase, and Cochrane libraries, and a meta-analysis was conducted based on the pathological results of the two treatments. Risk ratios (OR) or mean differences (MD) with 95% confidence intervals (CI) were calculated for the outcomes under random effects model. Results A total of 27 studies were included, including 3 randomized controlled studies, 2 prospective studies, and 22 retrospective studies, with a total of 3737 patients. The presence of perineural invasion (RR = 0.58, 95% CI 0.48, 0.71, P < 0.00001), lymphovascular invasion (RR = 0.68, 95% CI 0.47, 0.99, P = 0.004) and vascular invasion (RR = 0.66, 95% CI 0.45, 0.99, P = 0.04) in SEMS group were significantly higher than those in ES group, and there was no significant difference in lymphatic invasion (RR = 0.92, 95% CI 0.77, 1.09, P = 0.33). The number of lymph nodes harvested in SEMS group was significantly higher than that in ES group (MD = − 3.18, 95% CI − 4.47, − 1.90, P < 0.00001). While no significant difference was found in the number of positive lymph nodes (MD = − 0.11, 95% CI − 0.63, 0.42, P = 0.69) and N stage [N0 (RR = 1.03, 95% CI 0.92, 1.15, P = 0.60), N1 (RR = 0.99, 95% CI 0.87, 1.14, P = 0.91), N2 (RR = 0.94, 95% CI 0.77, 1.15, P = 0.53)]. Conclusions SEMS implantation in patients with acute malignant obstructive colorectal cancer may lead to an increase in adverse tumor pathological characteristics, and these characteristics are mostly related to the poor prognosis of colorectal cancer. Although the adverse effect of SEMS on long-term survival has not been demonstrated, their adverse effects cannot be ignored. The use of SEMS as the preferred treatment for patients with resectable obstructive colorectal cancer remains to be carefully weighed, especially when patients are young or the surgical risk is not very high.

scholarly journals Comparison of safety between self-expanding metal stents as a bridge to surgery and emergency surgery based on pathology: a meta-analysis

2020 ◽  
Author(s):  
Yang Hu ◽  
Jiajun Fan ◽  
Yifan Xv ◽  
Yingjie Hu ◽  
Yuan Ding ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Emergency Surgery ◽  
Meta Analysis ◽  
Metal Stents ◽  
Bridge To Surgery ◽  
Sems Group ◽  
Obstructive Colorectal Cancer ◽  
Significant Difference ◽  
Self Expanding Metal Stents

Abstract Background: To explore the long-term oncological safety of using self-expanding metal stents(SEMS) as a bridge to surgery for acute obstructive colorectal cancer by comparing the pathological results of emergency surgery(ES) with elective surgery after the placement of SEMS.Methods: Studies comparing SEMS as a bridge to surgery with emergency surgery for acute obstructive colorectal cancer were retrieved through the databases of Pubmed, Embase, and Cochrane libraries, and a meta-analysis was conducted based on the pathological results of the two treatments. Risk ratios(OR) or mean differences(MD) with 95% confidence intervals(CI) were calculated for the outcomes under random effects model.Results: A total of 27 studies were included, including 3 randomized controlled studies, 2 prospective studies, and 22 retrospective studies, with a total of 3737 patients. The presence of perineural invasion(RR=0.58, 95% CI=0.48, 0.71, P<0.00001), lymphovascular invasion(RR=0.68, 95%CI=0.47,0.99, P=0.004) and vascular invasion(RR=0.66, 95%CI=0.45,0.99, P=0.04) in SEMS group were significantly higher than those in ES group, and there was no significant difference in lymphatic invasion(RR=0.92, 95%CI=0.77,1.09, P=0.33). The number of lymph nodes harvested in SEMS group was significantly higher than that in ES group(MD=-3.18, 95% CI=-4.47,-1.90, P<0.00001). While no significant difference was found in the number of positive lymph nodes(MD=-0.11, 95%CI=-0.63,0.42, P=0.69) and N stage[N0(RR=1.03, 95%CI=0.92,1.15, P=0.60), N1(RR=0.99, 95%CI=0.87,1.14, P=0.91), N2(RR=0.94, 95%CI=0.77,1.15, P=0.53)]. Conclusions: SEMS implantation in patients with acute malignant obstructive colorectal cancer may lead to an increase in adverse tumor pathological characteristics, and these characteristics are mostly related to the poor prognosis of colorectal cancer. Although the adverse effect of SEMS on long-term survival has not been demonstrated, their adverse effects cannot be ignored. The use of SEMS as the preferred treatment for patients with resectable obstructive colorectal cancer remains to be carefully weighed, especially when patients are young or the surgical risk is not very high.

scholarly journals Comparison of safety between self-expanding metal stents as a bridge to surgery and emergency surgery based on pathology: a meta-analysis

2020 ◽  
Author(s):  
Yang Hu ◽  
Jiajun Fan ◽  
Yifan Xv ◽  
Yingjie Hu ◽  
Yuan Ding ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Emergency Surgery ◽  
Meta Analysis ◽  
Metal Stents ◽  
Bridge To Surgery ◽  
Sems Group ◽  
Obstructive Colorectal Cancer ◽  
Significant Difference ◽  
Self Expanding Metal Stents

Abstract Background: To explore the long-term oncological safety of using self-expanding metal stents(SEMS) as a bridge to surgery for acute obstructive colorectal cancer by comparing the pathological results of emergency surgery(ES) with elective surgery after the placement of SEMS. Methods: Studies comparing SMES as a bridge to surgery with emergency surgery for acute obstructive colorectal cancer were retrieved through the databases of Pubmed, Embase, and Cochrane libraries, and a meta-analysis was conducted based on the pathological results of the two treatments. Risk ratios(OR) or mean differences(MD) with 95% confidence intervals(CI) were calculated for the outcomes under random effects model. Results: A total of 27 studies were included, including 3 randomized controlled studies, 2 prospective studies, and 22 retrospective studies, with a total of 3737 patients. The presence ofperineural invasion(RR=0.58, 95% CI=0.48, 0.71, P<0.00001), lymphovascular invasion(RR=0.68, 95%CI=0.47,0.99, P=0.004) and vascular invasion(RR=0.66, 95%CI=0.45,0.99, P=0.04) in SEMS group were significantly higher than those in ES group, and there was no significant difference in lymphatic invasion(RR=0.92, 95%CI=0.77,1.09, P=0.33). The number of lymph nodes harvested in SEMS group was significantly higher than that in ES group(MD=-3.18, 95% CI=-4.47,-1.90, P<0.00001). While no significant difference was found in the number of positive lymph nodes(MD=-0.11, 95%CI=-0.63,0.42, P=0.69) and N stage[N0(RR=1.03, 95%CI=0.92,1.15, P=0.60), N1(RR=0.99, 95%CI=0.87,1.14, P=0.91), N2(RR=0.94, 95%CI=0.77,1.15, P=0.53)]. Conclusions: SEMS implantation in patients with acute malignant obstructive colorectal cancer may lead to an increase in adverse tumor pathological characteristics, and these characteristics are mostly related to the poor prognosis of colorectal cancer. Although the adverse effect of SEMS on long-term survival has not been demonstrated, it should not be considered as the first treatment for radically resectable colorectal cancer.

scholarly journals Current Status of the Self-Expandable Metal Stent as a Bridge to Surgery Versus Emergency Surgery in Colorectal Cancer: Results from an Updated Systematic Review and Meta-Analysis of the Literature

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 268
Author(s):  
Roberto Cirocchi ◽  
Alberto Arezzo ◽  
Paolo Sapienza ◽  
Daniele Crocetti ◽  
Davide Cavaliere ◽  
...  
Keyword(s):  
Systematic Review ◽  
Emergency Surgery ◽  
Primary Anastomosis ◽  
Meta Analysis ◽  
Long Term Results ◽  
Bridge To Surgery ◽  
Metal Stent ◽  
Sems Group ◽  
Short And Long Term

Background: The current use of endoscopic stenting as a bridge to surgery is not always accepted in standard clinical practice to treat neoplastic colonic obstructions. Objectives: The role of colonic self-expandable metal stent (SEMS) positioning as a bridge to resective surgery versus emergency surgery (ES) for malignant obstruction, using all new data and available variables, was studied and we focused on short- and long-term results. Materials and Methods: A systematic review with meta-analysis was performed. PubMed, SCOPUS and Web of Science databases were included. The search comprised only randomized controlled trials (RCTs) investigating the interventions that included SEMS positioning versus ES. The primary outcomes were the rates of overall postoperative mortality, clinical and technical success. The secondary outcomes were the short- and long-term results. Results: A total of 12 studies were eligible for further analyses. A laparoscopic colectomy was the most common operation performed in the SEMS group, whereas the traditional open approach was commonly used in the ES group. Intraoperative colonic lavage was seldomly performed during ES. There were no differences in mortality rates between the two groups (RR 1.06, 95% CI 0.55 to 2.04; I2 = 0%). In the SEMS group, the rate of successful primary anastomosis was significantly higher in of SEMS (69.75%) than in the ES (55.07%) (RR 1.26, 95% 245 CI 1.01 to 1.57; I2 = 86%). Conversely, the upfront Hartmann procedure was performed more frequently in the ES (39.1%) as compared to the SEMS group (23.4%) (RR 0.61, 95% CI 0.45 to 0.85; I2 = 23%). The overall postoperative complications rate was significantly lower in the SEMS group (32.74%) than in the ES group (48.25%) (RR 0.61, 95% CI 0.41 to 0.91; I2 = 65%). Conclusions: In the presence of malignant colorectal obstruction, SEMS is safe and associated with the same mortality and significantly lower morbidity than the ES group. The rate of successful primary anastomosis was significantly higher than the ES group. Nevertheless, recurrence and survival outcomes are not significantly different between the two groups. The analysis of short- and long-term results can suggest the use of SEMS as a bridge to resective surgery when it is performed by an endoscopist with adequate expertise in both colonoscopy and fluoroscopic techniques and who performed commonly colonic stenting.

scholarly journals Comparison of safety between self-expanding metal stents as a bridge to surgery and emergency surgery based on pathology: a meta-analysis

2020 ◽  
Author(s):  
Yang Hu ◽  
Jiajun Fan ◽  
Yifan Xv ◽  
Yingjie Hu ◽  
Yuan Ding ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Emergency Surgery ◽  
Meta Analysis ◽  
Metal Stents ◽  
Bridge To Surgery ◽  
Sems Group ◽  
Obstructive Colorectal Cancer ◽  
Significant Difference ◽  
Self Expanding Metal Stents

Abstract Background To explore the long-term oncological safety of using self-expanding metal stents(SEMS) as a bridge to surgery for acute obstructive colorectal cancer by comparing the pathological results of emergency surgery(ES) with elective surgery after the placement of SEMS.Methods Studies comparing SMES as a bridge to surgery with emergency surgery for acute obstructive colorectal cancer were retrieved through the databases of Pubmed, Embase, and Cochrane libraries, and a meta-analysis was conducted based on the pathological results of the two treatments. Risk ratios(OR) or mean differences(MD) with 95% confidence intervals(CI) were calculated for the outcomes under random effects model.Results A total of 27 studies were included, including 3 randomized controlled studies, 2 prospective studies, and 22 retrospective studies, with a total of 3737 patients. The presence of perineural invasion(RR=0.58, 95% CI=0.48, 0.71, P<0.00001), lymphovascular invasion(RR=0.68, 95%CI=0.47,0.99, P=0.004) and vascular invasion(RR=0.66, 95%CI=0.45,0.99, P=0.04) in SEMS group were significantly higher than those in ES group, and there was no significant difference in lymphatic invasion(RR=0.92, 95%CI=0.77,1.09, P=0.33). The number of lymph nodes harvested in SEMS group was significantly higher than that in ES group(MD=-3.18, 95% CI=-4.47,-1.90, P<0.00001). While no significant difference was found in the number of positive lymph nodes(MD=-0.11, 95%CI=-0.63,0.42, P=0.69) and N stage[N0(RR=1.03, 95%CI=0.92,1.15, P=0.60), N1(RR=0.99, 95%CI=0.87,1.14, P=0.91), N2(RR=0.94, 95%CI=0.77,1.15, P=0.53)]. Conclusions: SEMS implantation in patients with acute malignant obstructive colorectal cancer may lead to an increase in adverse tumor pathological characteristics, and these characteristics are mostly related to the poor prognosis of colorectal cancer. Although the adverse effect of SEMS on long-term survival has not been demonstrated, it should not be considered as the first treatment for radically resectable colorectal cancer.

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

2014 ◽  
Vol 22 (2) ◽  
pp. 497-504 ◽  
Author(s):  
Akihisa Matsuda ◽  
Masao Miyashita ◽  
Satoshi Matsumoto ◽  
Takeshi Matsutani ◽  
Nobuyuki Sakurazawa ◽  
...  
Keyword(s):  
Bowel Obstruction ◽  
Emergency Surgery ◽  
Large Bowel ◽  
Meta Analysis ◽  
Large Bowel Obstruction ◽  
Bridge To Surgery ◽  
Long Term Outcomes ◽  
Colonic Stent

scholarly journals Long-term oncologic outcomes of transanal TME compared with transabdominal TME for rectal cancer: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Jae Young Moon ◽  
Min Ro Lee ◽  
Gi Won Ha
Keyword(s):  
Rectal Cancer ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Distant Recurrence ◽  
Oncologic Outcomes ◽  
Cochrane Library ◽  
Transanal Total Mesorectal Excision ◽  
Random Effects Models ◽  
The Cochrane Library

Abstract Background Transanal total mesorectal excision (TaTME) appears to have favorable surgical and pathological outcomes. However, the evidence on survival outcomes remains unclear. We performed a meta-analysis to compare long-term oncologic outcomes of TaTME with transabdominal TME for rectal cancer. Methods PubMed, EMBASE, and the Cochrane Library were searched. Data were pooled, and overall effect size was calculated using random-effects models. Outcome measures were overall survival (OS), disease-free survival (DFS), and local and distant recurrence. Results We included 11 nonrandomized studies that examined 2,143 patients for the meta-analysis. There were no significant differences between the two groups in OS, DFS, and local and distant recurrence with a RR of 0.65 (95% CI 0.39–1.09, I2 = 0%), 0.79 (95% CI 0.57–1.10, I2 = 0%), 1.14 (95% CI 0.44–2.91, I2 = 66%), and 0.75 (95% CI 0.40–1.41, I2 = 0%), respectively. Conclusion In terms of long-term oncologic outcomes, TaTME may be an alternative to transabdominal TME in patients with rectal cancer. Well-designed randomized trials are warranted to further verify these results.

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