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Meta-analysis of randomized trials comparing endoscopic stenting and surgical decompression for colorectal cancer obstruction

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Surgical decompression is the traditional treatment for acute colorectal cancer obstruction. In recent years, colorectal stenting has been used to relieve the obstruction. This study used meta-analytic techniques to compare colonic stenting versus surgical decompression for colorectal cancer obstruction.

Methods

A comprehensive search of several databases was conducted. The search identified 321 potential abstracts and titles of which eight randomized trials involving 353 patients were retrieved in full text. A meta-analysis of the studies included was carried out to identify the differences in outcomes between the two procedures.

Results

The pooled analysis showed no significant differences for mortality (odds ratio (OR) 0.91) and morbidity (OR 2.05) rates between the two strategies while the permanent stoma creation rate was significantly higher in the surgical group as compared to the stent group (OR 3.12). By comparing surgery and colonic stenting in studies which analyzed the use of stenting as a “bridge to surgery,” the pooled analysis showed that primary anastomosis was more frequent in the stent group as compared to the surgical group (OR 0.42), and the stoma creation was more frequent in the surgical group as compared to the stent group (OR 2.36).

Conclusion

Our study suggested that, in patients with acute colorectal cancer obstruction, stent placement improved several outcomes, such as primary anastomosis, stoma formation, and permanent stoma, while it failed to show an improvement in mortality and morbidity risk.

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References

  1. Trompetas V (2008) Emergency management of malignant acute left-sided colonic obstruction. Ann R Coll Surg Engl 90:181–186

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  3. Leitman IM, Sullivan JD, Brams D et al (1992) Multivariate analysis of morbidity and mortality from the initial surgical management of obstructing carcinoma of the colon. Surg Gynecol Obstet 174:513–518

    PubMed  CAS  Google Scholar 

  4. Chen HS, Sheen-Chen SM (2000) Obstruction and perforation in colorectal adenocarcinoma: an analysis of prognosis and current trends. Surgery 127:370–376

    Article  PubMed  CAS  Google Scholar 

  5. Liu L, Herrinton LJ, Hornbrook MC et al (2010) Early and late complications among long-term colorectal cancer survivors with ostomy or anastomosis. Dis Colon Rectum 53:200–212

    Article  PubMed  Google Scholar 

  6. Khot UP, Lang AW, Murali K et al (2002) Systematic review of the efficacy and safety of colorectal stents. Br J Surg 89:1096–1102

    Article  PubMed  CAS  Google Scholar 

  7. Sebastian S, Johnston S, Geoghegan T et al (2004) Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol 99:2051–2057

    Article  PubMed  Google Scholar 

  8. Tilney HS, Lovegrove RE, Purkayastha S et al (2007) Comparison of colonic stenting and open surgery for malignant large bowel obstruction. Surg Endosc 21:225–233

    Article  PubMed  CAS  Google Scholar 

  9. Zhang Y, Shi J, Shi B et al (2012) Self-expanding metallic stent as a bridge to surgery versus emergency surgery for obstructive colorectal cancer: a meta-analysis. Surg Endosc 26:110–119

    Article  PubMed  CAS  Google Scholar 

  10. Greenland S (1998) Meta-analysis. In: Rothman KJ, Greenland S (eds) Modern epidemiology, 2nd edn. Lippincott, Philadelphia, pp 643–673

    Google Scholar 

  11. Juni P, Altman DG, Egger M (2001) Systematic reviews in health care: assessing the quality of controlled clinical trials. BMJ 323:42–46

    Article  PubMed  CAS  Google Scholar 

  12. Higgins J. Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0 (updated march 2011), chapter 9. The Cochrane collaboration, 2011. Available from www.cochrane-handbook.org. Accessed March 2012

  13. Fiori E, Lamazza A, De Cesare A et al (2004) Palliative management of malignant rectosigmoidal obstruction. Colostomy vs endoscopic stenting. A randomized prospective trial. Anticancer Res 24:265–268

    PubMed  Google Scholar 

  14. Xinopoulos D, Dimitroulopoulos D, Theodosopoulos T et al (2004) Stenting or stoma creation for patients with inoperable malignant colonic obstructions? Results of a study and cost-effectiveness analysis. Surg Endosc 18:421–426

    Article  PubMed  CAS  Google Scholar 

  15. van Hooft JE, Fockens P, Marinelli AW et al (2008) Early closure of a multicenter randomized clinical trial of endoscopic stenting versus surgery for stage IV left-sided colorectal cancer. Endoscopy 40:184–191

    Article  PubMed  Google Scholar 

  16. Cheung HY, Chung CC, Tsang WW et al (2009) Endolaparoscopic approach vs conventional open surgery in the treatment of obstructing left-sided colon cancer: a randomized controlled trial. Arch Surg 144:1127–1132

    Article  PubMed  Google Scholar 

  17. Pirlet IA, Slim K, Kwiatkowski F et al (2011) Emergency preoperative stenting versus surgery for acute left-sided malignant colonic obstruction: a multicenter randomized controlled trial. Surg Endosc 25:1814–1821

    Article  PubMed  Google Scholar 

  18. van Hooft JE, Bemelman WA, Oldenburg B et al (2011) Colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a multicentre randomised trial. Lancet Oncol 12:344–352

    Article  PubMed  Google Scholar 

  19. Alcántara M, Serra-Aracil X, Falcó J et al (2011) Prospective, controlled, randomized study of intraoperative colonic lavage versus stent placement in obstructive left-sided colonic cancer. World J Surg 35:1904–1910

    Article  PubMed  Google Scholar 

  20. Ho KS, Quah HM, Lim JF et al (2012) Endoscopic stenting and elective surgery versus emergency surgery for left-sided malignant colonic obstruction: a prospective randomized trial. Int J Colorectal Dis 3:355–362

    Article  Google Scholar 

  21. Sagar J (2011) Colorectal stents for the management of malignant colonic obstructions. Cochrane Database Syst Rev 9:11, CD007378

    Google Scholar 

  22. Sankararajah D, Forshaw MJ, Parker MC (2005) Multicentre prospective randomised controlled trial of pre-operative endoluminal stenting vs. surgery in large bowel obstruction—interim analysis of short term outcomes. Color Dis 7(Supple 1):45–143, Abstract 29

    Google Scholar 

  23. Saida Y, Sumiyama Y, Nagao J et al (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:S44–S49

    PubMed  Google Scholar 

  24. Baik SH, Kim NK, Cho HW et al (2006) Clinical outcomes of metallic stent insertion for obstructive colorectal cancer. Hepatogastroenterology 53:183–187

    PubMed  Google Scholar 

  25. Ng KC, Law WL, Lee YM et al (2006) Self-expanding metallic stent as a bridge to surgery versus emergency resection for obstructing left-sided colorectal cancer: a case-matched study. J Gastrointest Surg 10:798–803

    Article  PubMed  Google Scholar 

  26. Pessione S, Petruzzelli L, Gentilli S et al (2007) Treatment of neoplastic stenosis of the left colon: presurgical expandable metal stent vs emergency surgery comparison of results and survival rates. Chir Ital 59:661–669

    PubMed  Google Scholar 

  27. Dastur JK, Forshaw MJ, Modarai B et al (2008) Comparison of short- and long-term outcomes following either insertion of self-expanding metallic stents or emergency surgery in malignant large bowel obstruction. Tech Coloproctol 12:51–55

    Article  PubMed  CAS  Google Scholar 

  28. Xu K, Zhang H, Feng Y et al (2010) Comparison of the outcomes of preoperative stent insertion and emergency surgery in the treatment of obstructive left-sided colorectal cancer: an analysis of 248 cases. Shijie Huaren Xiaohua Zazhi 18:736–740 (in Chinese)

    Google Scholar 

  29. Baron TH (2010) Colonic stenting: a palliative measure only or a bridge to surgery? Endoscopy 42:163–168

    Article  PubMed  CAS  Google Scholar 

  30. Repici A, De Caro G, Luigiano C et al (2008) WallFlex colonic stent placement for management of malignant colonic obstruction: a prospective study at two centers. Gastrointest Endosc 67:77–84

    Article  PubMed  Google Scholar 

  31. Cennamo V, Fuccio L, Mutri V et al (2009) Does stent placement for advanced colon cancer increase the risk of perforation during bevacizumab-based therapy? Clin Gastroenterol Hepatol 7:1174–1176

    Article  PubMed  Google Scholar 

  32. Luigiano C, Ferrara F, Fabbri C et al (2011) Through-the-scope large diameter self-expanding metal stent placement as a safe and effective technique for palliation of malignant colorectal obstruction: a single center experience with a long-term follow-up. Scand J Gastroenterol 46:591–596

    Article  PubMed  Google Scholar 

  33. Luigiano C, Ferrara F, Pellicano R et al (2011) Short- and long-term outcomes of self-expanding metal stent placement as a bridge to surgery for acute left-sided colorectal cancer obstruction. Minerva Chir 66:501–508

    PubMed  CAS  Google Scholar 

  34. Jiménez-Pérez J, Casellas J, García-Cano J et al (2011) Colonic stenting as a bridge to surgery in malignant large-bowel obstruction: a report from two large multinational registries. Am J Gastroenterol 106:2174–2180

    Article  PubMed  Google Scholar 

  35. Meisner S, González-Huix F, Vandervoort JG et al (2011) Self-expandable metal stents for relieving malignant colorectal obstruction: short-term safety and efficacy within 30 days of stent procedure in 447 patients. Gastrointest Endosc 74:876–884

    Article  PubMed  Google Scholar 

  36. Horiuchi A, Nakayama Y, Tanaka N et al (2005) Acute colorectal obstruction treated by means of transanal drainage tube: effectiveness before surgery and stenting. Am J Gastroenterol 100:2765–2770

    Article  PubMed  Google Scholar 

  37. Wong RW, Rappaport WD, Witzke DB et al (1994) Factors influencing the safety of colostomy closure in the elderly. J Surg Res 57:289–292

    Article  PubMed  CAS  Google Scholar 

  38. Lee YM, Law WL, Chu KW et al (2001) Emergency surgery for obstructing colorectal cancers: a comparison between right-sided and left-sided lesions. J Am Coll Surg 192:719–725

    Article  PubMed  CAS  Google Scholar 

  39. Ansaloni L, Andersson RE, Bazzoli F et al (2010) Guidelenines in the management of obstructing cancer of the left colon: consensus conference of the world society of emergency surgery (WSES) and peritoneum and surgery (PnS) society. World J Emerg Surg 5:29

    Article  PubMed  Google Scholar 

  40. Nagula S, Ishill N, Nash C et al (2010) Quality of life and symptom control after stent placement or surgical palliation of malignant colorectal obstruction. J Am Coll Surg 210:45–53

    Article  PubMed  Google Scholar 

  41. Varadarajulu S, Roy A, Lopes T et al (2011) Endoscopic stenting versus surgical colostomy for the management of malignant colonic obstruction: comparison of hospital costs and clinical outcomes. Surg Endosc 25:2203–2209

    Article  PubMed  Google Scholar 

  42. Maruthachalam K, Lash GE, Shenton BK et al (2007) Tumour cell dissemination following endoscopic stent insertion. Br J Surg 94:1151–1154

    Article  PubMed  CAS  Google Scholar 

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Conflict of interest

Neither this submitted paper nor any similar paper, in whole or in part, has been or will be submitted to any other primary scientific journal. All authors reviewed this manuscript and agreed with the contents. There are no financial arrangements or commercial associations (e.g., equity ownership or interest, consultancy, patent and licensing agreement, or institutional and corporate associations) that might be a conflict of interest in relation to the submitted manuscript.

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Authors and Affiliations

  1. Unit of Digestive Endoscopy, Department of Surgery, AUSL Bologna Bellaria Hospital, Via Altura, 40139, Bologna, Italy

    Vincenzo Cennamo, Carlo Fabbri, Marco Bassi, Liza Ceroni & Antonella Maimone

  2. Unit of Gastroenterology and Digestive Endoscopy, ARNAS Garibaldi, Catania, Italy

    Carmelo Luigiano

  3. Unit of Gastroenterology and Digestive Endoscopy, AO Treviglio-Caravaggio, Treviglio, Italy

    Giuseppe De Caro

  4. Unit of Gastroenterology, Ospedali Riuniti, Bergamo, Italy

    Paolo Ravelli

  5. Unit of General Surgery, Ospedali Riuniti, Bergamo, Italy

    Federico Coccolini & Luca Ansaloni

Authors
  1. Vincenzo Cennamo
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  2. Carmelo Luigiano
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  3. Federico Coccolini
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  4. Carlo Fabbri
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Correspondence to Vincenzo Cennamo.

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Cennamo, V., Luigiano, C., Coccolini, F. et al. Meta-analysis of randomized trials comparing endoscopic stenting and surgical decompression for colorectal cancer obstruction. Int J Colorectal Dis 28, 855–863 (2013). https://doi.org/10.1007/s00384-012-1599-z

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  • DOI: https://doi.org/10.1007/s00384-012-1599-z

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