Meta-analysis of safety and effectiveness of stent placement and emergency surgery in treatment of proximal colon cancer obstruction_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Shiyao ¹ , HU Huan ¹ , ZHANG Xiangxiang ² , WANG Keshen ¹ , ZHENG Pengfei ¹ ,  CHENG Zhibin ¹

1. Department of Hepatobiliary Surgery, The Second Hospital of Lanzhou University, Lanzhou 730000, P. R. China;
2. Department of Urinary Surgery, The Second Hospital of Lanzhou University, Lanzhou 730000, P. R. China;

Corresponding author：

CHENG Zhibin, Email: zhibin_cheng@hotmail.com

Keywords：

colon cancer; intestinal obstruction; stent implantation; emergency surgery; safety; effectiveness

DOI：

10.7507/1007-9424.201902005

Video：

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Objective To evaluate safety and effectiveness of stent placement and emergency surgery in treatment of proximal colon cancer obstruction.Methods The PubMed, Embase, Cochrane Library, ClinicalTrials, CNKI, CBM, Wanfang Data, etc. were searched comprehensively. The literatures of Chinese and English randomized controlled trial and retrospective comparative study of stent placement and emergency surgery for the proximal colon cancer obstruction were retrieved. The RevMan 5.3 and Stata 12.0 softwares were used. The meta-analysis was made on the safety and effectiveness of these two treatments.Results A total of 9 literatures involving 636 patients were included, all of them were the retrospective studies, 4 of them only reported the clinical success rate and technical success rate. The technical success rate of stent placement was 0.94 [95% CI (0.91, 0.96)]. The clinical success rate was 0.90 [95% CI (0.87, 0.93)]. Compared with the emergency surgery group, the total complication rate and the temporary stoma rate were lower [OR=0.32, 95% CI (0.11, 0.94), P=0.04; OR=0.18, 95% CI (0.05, 0.65), P=0.009] and the hospital stay was shorter [MD=–2.97, 95% CI (–4.52, –1.41), P=0.000 2] in the stent placement group. The perioperative mortality rate, laparoscopic surgery rate, 5-year disease-free survival rate, and 5-year overall survival rate had no significant differences between these two groups (P>0.05).Conclusion Compared with emergency surgery, endoscopic stent placement for treatment of proximal colon cancer obstruction has a lower incidence of complications, temporary colostomy rate, shorter hospital stay, and it has no significant differences in mortality, laparoscopic surgery rate, and survival rate.

Citation： WANG Shiyao, HU Huan, ZHANG Xiangxiang, WANG Keshen, ZHENG Pengfei, CHENG Zhibin. Meta-analysis of safety and effectiveness of stent placement and emergency surgery in treatment of proximal colon cancer obstruction. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(7): 834-840. doi: 10.7507/1007-9424.201902005 Copy

1.	陈万青, 孙可欣, 郑荣寿, 等. 2014年中国分地区恶性肿瘤发病和死亡分析. 中国肿瘤, 2018, 27(1): 1-14.
2.	Frago R, Ramirez E, Millan M, et al. Current management of acute malignant large bowel obstruction: a systematic review. Am J Surg, 2014, 207(1): 127-138.
3.	Dohmoto M. New method-Endoscopic implantation of rectal stent in palliative treatment of colorectal neoplastic obstructions. Endosc Dig, 1991, 3: 1507-1512.
4.	尚培中, 刘景章, 卢育奇, 等. 记忆合金支架在直肠癌伴梗阻患者中的应用. 中国普外基础与临床杂志, 2002, 9(1): 34-35.
5.	Wang X, He J, Chen X, et al. Stenting as a bridge to resection versus emergency surgery for left-sided colorectal cancer with malignant obstruction: A systematic review and meta-analysis. Int J Surg, 2017, 48: 64-68.
6.	Fiori E, Lamazza A, Sterpetti AV. Endoscopic Stenting as a bridge to surgery in left-sided obstructing colorectal cancer: a useful tool in selected patients. Dig Surg, 2017, 34(6): 521-522.
7.	王红岩, 董齐, 柳青峰, 等. 肠梗阻导管在结直肠癌性肠梗阻治疗中的应用研究. 中国普外基础与临床杂志, 2009, 16(9): 698-701.
8.	尚培中, 苗建军, 贾国洪, 等. 微创外科技术在结直肠癌伴梗阻治疗中的临床应用. 中国普外基础与临床杂志, 2011, 18(4): 406-410.
9.	Ji WB, Kwak JM, Kang DW, et al. Clinical benefits and oncologic equivalence of self-expandable metallic stent insertion for right-sided malignant colonic obstruction. Surg Endosc, 2017, 31(1): 153-158.
10.	He S, Cao Y, Qin W, et al. Prevalence of primary cardiac tumor malignancies in retrospective studies over six decades: a systematic review and meta-analysis. Oncotarget, 2017, 8(26): 43284-43294.
11.	Kye BH, Lee YS, Cho HM, et al. 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, 2016, 23(6): 1867-1874.
12.	Siddiqui A, Cosgrove N, Yan LH, et al. Long-term outcomes of palliative colonic stenting versus emergency surgery for acute proximal malignant colonic obstruction: a multicenter trial. Endosc Int Open, 2017, 5(4): E232-E238.
13.	Amelung FJ, Draaisma WA, Consten ECJ, et al. Self-expandable metal stent placement versus emergency resection for malignant proximal colon obstructions. Surg Endosc, 2017, 31(11): 4532-4541.
14.	van den Berg MW, Sloothaak DA, Dijkgraaf MG, et al. Bridge-to-surgery stent placement versus emergency surgery for acute malignant colonic obstruction. Br J Surg, 2014, 101(7): 867-873.
15.	Yoon J, Kwon SH, Lee CK, et al. Radiologic placement of uncovered stents for the treatment of malignant colonic obstruction proximal to the descending colon. Cardiovasc Intervent Radiol, 2017, 40(1): 99-105.
16.	Dronamraju SS, Ramamurthy S, Kelly SB, et al. Role of self-expanding metallic stents in the management of malignant obstruction of the proximal colon. Dis Colon Rectum, 2009, 52(9): 1657-1661.
17.	Yao LQ, Zhong YS, Xu MD, et al. Self-expanding metallic stents drainage for acute proximal colon obstruction. World J Gastroenterol, 2011, 17(28): 3342-3346.
18.	Cho YK, Kim SW, Lee BI, et al. Clinical outcomes of self-expandable metal stent placement in the management of malignant proximal colon obstruction. Dig Endosc, 2010, 22(4): A52-A53.
19.	Morita S, Yamamoto K, Ogawa A, et al. Benefits of using a self-expandable metallic stent as a bridge to surgery for right- and left-sided obstructive colorectal cancers. Surg Today, 2019, 49(1): 32-37.
20.	康泰, 韩新巍, 任建庄, 等. DSA下支架置入对于右半结肠癌性梗阻的疗效与价值. 临床放射学杂志, 2017, 36(3): 411-414.
21.	Lapenta R, Lucidi C, Assisi D, et al. Efficacy and safety of self-expanding metal stents for colon cancer: An analysis of 10 years’ experience of a third referral center. Dig Liver Dis, 2017, 49: e184-e185.
22.	Amelung FJ, Burghgraef TA, Tanis PJ, et al. Critical appraisal of oncological safety of stent as bridge to surgery in left-sided obstructing colon cancer; a systematic review and meta-analysis. Crit Rev Oncol Hematol, 2018, 131: 66-75.
23.	Verstockt B, Van Driessche A, De Man M, et al. Ten-year survival after endoscopic stent placement as a bridge to surgery in obstructing colon cancer. Gastrointest Endosc, 2018, 87(3): 705-713.
24.	Kuwai T, Kyo R, Yoshida S, et al. A prospective, multicenter study of palliative colonic stenting for malignant colorectal obstruction in Japan: Long-term efficacy and safety in 87 patients. Gastrointest Endosc, 2017, 85(5): B254.
25.	Choi JM, Lee C, Han YM, et al. Long-term oncologic outcomes of endoscopic stenting as a bridge to surgery for malignant colonic obstruction: comparison with emergency surgery. Surg Endosc, 2014, 28(9): 2649-2655.
26.	Erichsen R, Horváth-Puhó E, Jacobsen JB, et al. Long-term mortality and recurrence after colorectal cancer surgery with preoperative stenting: a Danish nationwide cohort study. Endoscopy, 2015, 47(6): 517-524.

1. 陈万青, 孙可欣, 郑荣寿, 等. 2014年中国分地区恶性肿瘤发病和死亡分析. 中国肿瘤, 2018, 27(1): 1-14.
2. Frago R, Ramirez E, Millan M, et al. Current management of acute malignant large bowel obstruction: a systematic review. Am J Surg, 2014, 207(1): 127-138.
3. Dohmoto M. New method-Endoscopic implantation of rectal stent in palliative treatment of colorectal neoplastic obstructions. Endosc Dig, 1991, 3: 1507-1512.
4. 尚培中, 刘景章, 卢育奇, 等. 记忆合金支架在直肠癌伴梗阻患者中的应用. 中国普外基础与临床杂志, 2002, 9(1): 34-35.
5. Wang X, He J, Chen X, et al. Stenting as a bridge to resection versus emergency surgery for left-sided colorectal cancer with malignant obstruction: A systematic review and meta-analysis. Int J Surg, 2017, 48: 64-68.
6. Fiori E, Lamazza A, Sterpetti AV. Endoscopic Stenting as a bridge to surgery in left-sided obstructing colorectal cancer: a useful tool in selected patients. Dig Surg, 2017, 34(6): 521-522.
7. 王红岩, 董齐, 柳青峰, 等. 肠梗阻导管在结直肠癌性肠梗阻治疗中的应用研究. 中国普外基础与临床杂志, 2009, 16(9): 698-701.
8. 尚培中, 苗建军, 贾国洪, 等. 微创外科技术在结直肠癌伴梗阻治疗中的临床应用. 中国普外基础与临床杂志, 2011, 18(4): 406-410.
9. Ji WB, Kwak JM, Kang DW, et al. Clinical benefits and oncologic equivalence of self-expandable metallic stent insertion for right-sided malignant colonic obstruction. Surg Endosc, 2017, 31(1): 153-158.
10. He S, Cao Y, Qin W, et al. Prevalence of primary cardiac tumor malignancies in retrospective studies over six decades: a systematic review and meta-analysis. Oncotarget, 2017, 8(26): 43284-43294.
11. Kye BH, Lee YS, Cho HM, et al. 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, 2016, 23(6): 1867-1874.
12. Siddiqui A, Cosgrove N, Yan LH, et al. Long-term outcomes of palliative colonic stenting versus emergency surgery for acute proximal malignant colonic obstruction: a multicenter trial. Endosc Int Open, 2017, 5(4): E232-E238.
13. Amelung FJ, Draaisma WA, Consten ECJ, et al. Self-expandable metal stent placement versus emergency resection for malignant proximal colon obstructions. Surg Endosc, 2017, 31(11): 4532-4541.
14. van den Berg MW, Sloothaak DA, Dijkgraaf MG, et al. Bridge-to-surgery stent placement versus emergency surgery for acute malignant colonic obstruction. Br J Surg, 2014, 101(7): 867-873.
15. Yoon J, Kwon SH, Lee CK, et al. Radiologic placement of uncovered stents for the treatment of malignant colonic obstruction proximal to the descending colon. Cardiovasc Intervent Radiol, 2017, 40(1): 99-105.
16. Dronamraju SS, Ramamurthy S, Kelly SB, et al. Role of self-expanding metallic stents in the management of malignant obstruction of the proximal colon. Dis Colon Rectum, 2009, 52(9): 1657-1661.
17. Yao LQ, Zhong YS, Xu MD, et al. Self-expanding metallic stents drainage for acute proximal colon obstruction. World J Gastroenterol, 2011, 17(28): 3342-3346.
18. Cho YK, Kim SW, Lee BI, et al. Clinical outcomes of self-expandable metal stent placement in the management of malignant proximal colon obstruction. Dig Endosc, 2010, 22(4): A52-A53.
19. Morita S, Yamamoto K, Ogawa A, et al. Benefits of using a self-expandable metallic stent as a bridge to surgery for right- and left-sided obstructive colorectal cancers. Surg Today, 2019, 49(1): 32-37.
20. 康泰, 韩新巍, 任建庄, 等. DSA下支架置入对于右半结肠癌性梗阻的疗效与价值. 临床放射学杂志, 2017, 36(3): 411-414.
21. Lapenta R, Lucidi C, Assisi D, et al. Efficacy and safety of self-expanding metal stents for colon cancer: An analysis of 10 years’ experience of a third referral center. Dig Liver Dis, 2017, 49: e184-e185.
22. Amelung FJ, Burghgraef TA, Tanis PJ, et al. Critical appraisal of oncological safety of stent as bridge to surgery in left-sided obstructing colon cancer; a systematic review and meta-analysis. Crit Rev Oncol Hematol, 2018, 131: 66-75.
23. Verstockt B, Van Driessche A, De Man M, et al. Ten-year survival after endoscopic stent placement as a bridge to surgery in obstructing colon cancer. Gastrointest Endosc, 2018, 87(3): 705-713.
24. Kuwai T, Kyo R, Yoshida S, et al. A prospective, multicenter study of palliative colonic stenting for malignant colorectal obstruction in Japan: Long-term efficacy and safety in 87 patients. Gastrointest Endosc, 2017, 85(5): B254.
25. Choi JM, Lee C, Han YM, et al. Long-term oncologic outcomes of endoscopic stenting as a bridge to surgery for malignant colonic obstruction: comparison with emergency surgery. Surg Endosc, 2014, 28(9): 2649-2655.
26. Erichsen R, Horváth-Puhó E, Jacobsen JB, et al. Long-term mortality and recurrence after colorectal cancer surgery with preoperative stenting: a Danish nationwide cohort study. Endoscopy, 2015, 47(6): 517-524.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Meta-analysis of safety and effectiveness of stent placement and emergency surgery in treatment of proximal colon cancer obstruction

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