Efficacy and safety of selective surgery after colonic stenting <i>versus</i> emergency surgery foracute obstructive colorectal cancer: a meta-analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 CAI Shengbin ¹ , MA Xianhua ²

1. Department of General Surgery, Suzhou Dushuhu Public Hospital/Dushuhu Public Hospital Affiliated to Soochow University, Suzhou, Jiangsu 215006, P. R. China;
2. Department of Oncology, Suzhou Dushuhu Public Hospital/Dushuhu Public Hospital Affiliated to Soochow University, Suzhou, Jiangsu 215006, P. R. China;

Corresponding author：

CAI Shengbin, Email: shengbin117@sina.com

Keywords：

colorectal cancer; acute large bowel obstruction; colonic stent; selective surgery; emergency surgery; meta analysis

DOI：

10.7507/1007-9424.201906036

Video：

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Objective The aim of this current meta-analysis is to evaluate the efficacy and safety of selective surgery after colonic stenting versus emergency surgery for acute obstructive colorectal cancer.Methods The studies published from January 1, 2000 to July 31, 2018 were searched from Pubmed, Embase, Cochrane Library, CNKI, Wanfang database, and VIP database. RevMan 5.3 software was used for data analysis.Results A total of 21 studies were included in this meta-analysis. Compared to emergency surgery, selective surgery after colonic stenting had significant lower mortality rate [OR=0.44, 95% CI was (0.26, 0.73), P<0.05], permanent stoma rate [OR=0.46, 95% CI was (0.23, 0.94), P<0.05], complication rate [OR=0.47, 95% CI was (0.35, 0.63), P<0.05], and wound infection rate [OR=0.40, 95% CI was (0.25, 0.65), P<0.05）], but had significant higher primary anastomosis rate [OR=3.30, 95% CI was (2.47, 4.41), P<0.05] and laparoscopic surgery rate [OR=12.55, 95% CI was (3.64, 43.25), P<0.05]. But there was no significant differences between the two groups as to anastomotic leak rate [OR=0.86, 95% CI was (0.48, 1.55), P>0.05].Conclusions Selective surgery after colonic stenting can be identified in a reduced incidence of mortality rate, complication rate, permanent stoma rate, and wound infection rate, and also can increase primary anastomosis rate and laparoscopic surgery rate. Thus, for acute obstructive colorectal cancer, selective surgery after colonic stenting is better than emergency surgery.

Citation： CAI Shengbin, MA Xianhua. Efficacy and safety of selective surgery after colonic stenting versus emergency surgery foracute obstructive colorectal cancer: a meta-analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(11): 1320-1329. doi: 10.7507/1007-9424.201906036 Copy

1.	陈万青, 郑荣寿, 张思维, 等. 2013年中国恶性肿瘤发病和死亡分析. 中国肿瘤, 2017, 26(1): 1-7.
2.	Öistämö E, Hjern F, Blomqvist L, et al. Emergency management with resection versus proximal stoma or stent treatment and planned resection in malignant left-sided colon obstruction. World J Surg Oncol, 2016, 14(1): 232.
3.	Tekkis PP, Kinsman R, Thompson MR, et al. The Association of Coloproctology of Great Britain and Ireland study of large bowel obstruction caused by colorectal cancer. Ann Surg, 2004, 240(1): 76-81.
4.	Law WL, Choi HK, Chu KW. Comparison of stenting with emergency surgery as palliative treatment for obstructing primary left-sided colorectal cancer. Br J Surg, 2003, 90(11): 1429-1433.
5.	De Salvo GL, Gava C, Pucciarelli S, et al. Curative surgery for obstruction from primary left colorectal carcinoma: primary or staged resection? Cochrane Database Syst Rev, 2002, (1): CD002101.
6.	Saida Y, Sumiyama Y, Nagao J, et al. 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-S49.
7.	Martinez-Santos C, Lobato RF, Fradejas JM, et al. Self-expandable stent before elective surgery vs. emergency surgery for the treatment of malignant colorectal obstructions: comparison of primary anastomosis and morbidity rates. Dis Colon Rectum, 2002, 45(3): 401-406.
8.	Pearce NW, Scott SD, Karran SJ. Timing and method of reversal of Hartmann’s procedure. Br J Surg, 1992, 79(8): 839-841.
9.	Arezzo A, Balague C, Targarona E, et al. Colonic stenting as a bridge to surgery versus emergency surgery for malignant colonic obstruction: results of a multicentre randomised controlled trial (ESCO trial). Surg Endosc, 2017, 31(8): 3297-3305.
10.	Kang D, Kim H, Choi C, et al. P-060Endoscopic colorectal stenting for malignant large bowel obstruction comparing to surgery. Ann Oncol, 2016, 27(Suppl 2): ii18.
11.	Ribeiro I, Pinho R, Leite M, et al. 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, 2016, 23(2): 76-83.
12.	Min CK, Kim HO, Lee D, et al. Obstructive left colon cancer should be managed by using a subtotal colectomy instead of colonic stenting. Ann Coloproctol, 2016, 32(6): 215-220.
13.	Fernandes D, Domingues S, Gonçalves BM, et al. Acute treatment of malignant colorectal occlusion: real life practice. GE Port J Gastroenterol, 2016, 23(2): 66-75.
14.	van Hooft JE, Bemelman WA, Oldenburg B, et al. Colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a multicentre randomised trial. Lancet Oncol, 2011, 12(4): 344-352.
15.	Pirlet IA, Slim K, Kwiatkowski F, et al. Emergency preoperative stenting versus surgery for acute left-sided malignant colonic obstruction: a multicenter randomized controlled trial. Surg Endosc, 2011, 25(6): 1814-1821.
16.	Varadarajulu S, Roy A, Lopes T, et al. Endoscopic stenting versus surgical colostomy for the management of malignant colonic obstruction: comparison of hospital costs and clinical outcomes. Surg Endosc, 2011, 25(7): 2203-2209.
17.	Amelung FJ, Consten ECJ, Siersema PD, et al. A population-based analysis of three treatment modalities for malignant obstruction of the proximal colon: acute resection versus stent or stoma as a bridge to surgery. Ann Surg Oncol, 2016, 23(11): 3660-3668.
18.	Nur AO. Safety of laparoscopic approach in acute obstructive left side colorectal cancer after insertion of self-expandable metallic stent. 大连: 大连医科大学, 2017.
19.	朱为民. 肠道支架置入术在结直肠癌肠梗阻治疗中的应用. 浙江: 浙江大学, 2017.
20.	Alcántara M, Serra-Aracil X, Falcó J, et al. Prospective, controlled, randomized study of intraoperative colonic lavage versus stent placement in obstructive left-sided colonic cancer. World J Surg, 2011, 35(8): 1904-1910.
21.	Cheung HY, Chung CC, Tsang WW, et al. Endolaparoscopic approach vs conventional open surgery in the treatment of obstructing left-sided colon cancer: a randomized controlled trial. Arch Surg, 2009, 144(12): 1127-1132.
22.	Ghazal AH, El-Shazly WG, Bessa SS, et al. Colonic endolumenal stenting devices and elective surgery versus emergency subtotal/total colectomy in the management of malignant obstructed left colon carcinoma. J Gastrointest Surg, 2013, 17(6): 1123-1129.
23.	Guo MG, Feng Y, Zheng Q, et al. Comparison of self-expanding metal stents and urgent surgery for left-sided malignant colonic obstruction in elderly patients. Dig Dis Sci, 2011, 56(9): 2706-2710.
24.	Ho KM, Chan KM, Kwok SY, et al. Colonic self-expanding metal stent (SEMS) as a bridge to surgery in left-sided malignant colonic obstruction: an 8-year review. Surg Endosc, 2017, 31(5): 2255-2262.
25.	Ho KS, Quah HM, Lim JF, et al. Endoscopic stenting and elective surgery versus emergency surgery for left-sided malignant colonic obstruction: a prospective randomized trial. Int J Colorectal Dis, 2012, 27(3): 355-362.
26.	Kavanagh DO, Nolan B, Judge C, et al. A comparative study of short- and medium-term outcomes comparing emergent surgery and stenting as a bridge to surgery in patients with acute malignant colonic obstruction. Dis Colon Rectum, 2013, 56(4): 433-440.
27.	Occhionorelli S, Tartarini D, Cappellari L, et al. Colonic stent placement as a bridge to surgery in patients with left-sided malignant large bowel obstruction. An observational study. G Chir, 2014, 35(11-12): 283-289.
28.	Deans GT, Krukowski ZH, Irwin ST. Malignant obstruction of the left colon. Br J Surg, 1994, 81(9): 1270-1276.
29.	Riedl S, Wiebelt H, Bergmann U, et al. Postoperative complications and fatalities in surgical therapy of colon carcinoma. Results of the German multicenter study by the Colorectal Carcinoma Study Group. Chirurg, 1995, 66(6): 597-606.
30.	Sebastian S, Johnston S, Geoghegan T, et al. Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol, 2004, 99(10): 2051-2057.
31.	Meisner S, Hensler M, Knop FK, et al. Self-expanding metal stents for colonic obstruction: experiences from 104 procedures in a single center. Dis Colon Rectum, 2004, 47(4): 444-450.
32.	谢正勇, 李泽航, 程黎阳, 等. 开腹术与腹腔镜治疗结直肠癌对其手术情况、术后恢复及复发转移的对比研究. 现代消化及介入诊疗, 2018, 23(3): 382-385.
33.	Watt AM, Faragher IG, Griffin TT, et al. Self-expanding metallic stents for relieving malignant colorectal obstruction: a systematic review. Ann Surg, 2007, 246(1): 24-30.
34.	Shimizu H, Yamazaki R, Ohtsuka H, et al. Feasibility of laparoscopic surgery after stent insertion for obstructive colorectal cancer. Asian J Endosc Surg, 2018, 11(2): 118-122.
35.	Kim EJ, Kim YJ. Stents for colorectal obstruction: past, present, and future. World J Gastroenterol, 2016, 22(2): 842-852.
36.	Khot UP, Lang AW, Murali K, et al. Systematic review of the efficacy and safety of colorectal stents. Br J Surg, 2002, 89(9): 1096-1102.
37.	Small AJ, Coelho-Prabhu N, Baron TH. Endoscopic placement of self-expandable metal stents for malignant colonic obstruction: long-term outcomes and complication factors. Gastrointest Endosc, 2010, 71(3): 560-572.
38.	Cennamo V, Fuccio L, Mutri V, et al. Does stent placement for advanced colon cancer increase the risk of perforation during bevacizumab-based therapy? Clin Gastroenterol Hepatol, 2009, 7(11): 1174-1176.
39.	Manes G, de Bellis M, Fuccio L, et al. Endoscopic palliation in patients with incurable malignant colorectal obstruction by means of self-expanding metal stent: analysis of results and predictors of outcomes in a large multicenter series. Arch Surg, 2011, 146(10): 1157-1162.
40.	Mabardy A, Miller P, Goldstein R, et al. Stenting for obstructing colon cancer: fewer complications and colostomies. JSLS, 2015, 19(1): e2014.
41.	Huang X, Lv B, Zhang S, et al. Preoperative colonic stents versus emergency surgery for acute left-sided malignant colonic obstruction: a meta-analysis. J Gastrointest Surg, 2014, 18(3): 584-591.
42.	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.

1. 陈万青, 郑荣寿, 张思维, 等. 2013年中国恶性肿瘤发病和死亡分析. 中国肿瘤, 2017, 26(1): 1-7.
2. Öistämö E, Hjern F, Blomqvist L, et al. Emergency management with resection versus proximal stoma or stent treatment and planned resection in malignant left-sided colon obstruction. World J Surg Oncol, 2016, 14(1): 232.
3. Tekkis PP, Kinsman R, Thompson MR, et al. The Association of Coloproctology of Great Britain and Ireland study of large bowel obstruction caused by colorectal cancer. Ann Surg, 2004, 240(1): 76-81.
4. Law WL, Choi HK, Chu KW. Comparison of stenting with emergency surgery as palliative treatment for obstructing primary left-sided colorectal cancer. Br J Surg, 2003, 90(11): 1429-1433.
5. De Salvo GL, Gava C, Pucciarelli S, et al. Curative surgery for obstruction from primary left colorectal carcinoma: primary or staged resection? Cochrane Database Syst Rev, 2002, (1): CD002101.
6. Saida Y, Sumiyama Y, Nagao J, et al. 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-S49.
7. Martinez-Santos C, Lobato RF, Fradejas JM, et al. Self-expandable stent before elective surgery vs. emergency surgery for the treatment of malignant colorectal obstructions: comparison of primary anastomosis and morbidity rates. Dis Colon Rectum, 2002, 45(3): 401-406.
8. Pearce NW, Scott SD, Karran SJ. Timing and method of reversal of Hartmann’s procedure. Br J Surg, 1992, 79(8): 839-841.
9. Arezzo A, Balague C, Targarona E, et al. Colonic stenting as a bridge to surgery versus emergency surgery for malignant colonic obstruction: results of a multicentre randomised controlled trial (ESCO trial). Surg Endosc, 2017, 31(8): 3297-3305.
10. Kang D, Kim H, Choi C, et al. P-060Endoscopic colorectal stenting for malignant large bowel obstruction comparing to surgery. Ann Oncol, 2016, 27(Suppl 2): ii18.
11. Ribeiro I, Pinho R, Leite M, et al. 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, 2016, 23(2): 76-83.
12. Min CK, Kim HO, Lee D, et al. Obstructive left colon cancer should be managed by using a subtotal colectomy instead of colonic stenting. Ann Coloproctol, 2016, 32(6): 215-220.
13. Fernandes D, Domingues S, Gonçalves BM, et al. Acute treatment of malignant colorectal occlusion: real life practice. GE Port J Gastroenterol, 2016, 23(2): 66-75.
14. van Hooft JE, Bemelman WA, Oldenburg B, et al. Colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a multicentre randomised trial. Lancet Oncol, 2011, 12(4): 344-352.
15. Pirlet IA, Slim K, Kwiatkowski F, et al. Emergency preoperative stenting versus surgery for acute left-sided malignant colonic obstruction: a multicenter randomized controlled trial. Surg Endosc, 2011, 25(6): 1814-1821.
16. Varadarajulu S, Roy A, Lopes T, et al. Endoscopic stenting versus surgical colostomy for the management of malignant colonic obstruction: comparison of hospital costs and clinical outcomes. Surg Endosc, 2011, 25(7): 2203-2209.
17. Amelung FJ, Consten ECJ, Siersema PD, et al. A population-based analysis of three treatment modalities for malignant obstruction of the proximal colon: acute resection versus stent or stoma as a bridge to surgery. Ann Surg Oncol, 2016, 23(11): 3660-3668.
18. Nur AO. Safety of laparoscopic approach in acute obstructive left side colorectal cancer after insertion of self-expandable metallic stent. 大连: 大连医科大学, 2017.
19. 朱为民. 肠道支架置入术在结直肠癌肠梗阻治疗中的应用. 浙江: 浙江大学, 2017.
20. Alcántara M, Serra-Aracil X, Falcó J, et al. Prospective, controlled, randomized study of intraoperative colonic lavage versus stent placement in obstructive left-sided colonic cancer. World J Surg, 2011, 35(8): 1904-1910.
21. Cheung HY, Chung CC, Tsang WW, et al. Endolaparoscopic approach vs conventional open surgery in the treatment of obstructing left-sided colon cancer: a randomized controlled trial. Arch Surg, 2009, 144(12): 1127-1132.
22. Ghazal AH, El-Shazly WG, Bessa SS, et al. Colonic endolumenal stenting devices and elective surgery versus emergency subtotal/total colectomy in the management of malignant obstructed left colon carcinoma. J Gastrointest Surg, 2013, 17(6): 1123-1129.
23. Guo MG, Feng Y, Zheng Q, et al. Comparison of self-expanding metal stents and urgent surgery for left-sided malignant colonic obstruction in elderly patients. Dig Dis Sci, 2011, 56(9): 2706-2710.
24. Ho KM, Chan KM, Kwok SY, et al. Colonic self-expanding metal stent (SEMS) as a bridge to surgery in left-sided malignant colonic obstruction: an 8-year review. Surg Endosc, 2017, 31(5): 2255-2262.
25. Ho KS, Quah HM, Lim JF, et al. Endoscopic stenting and elective surgery versus emergency surgery for left-sided malignant colonic obstruction: a prospective randomized trial. Int J Colorectal Dis, 2012, 27(3): 355-362.
26. Kavanagh DO, Nolan B, Judge C, et al. A comparative study of short- and medium-term outcomes comparing emergent surgery and stenting as a bridge to surgery in patients with acute malignant colonic obstruction. Dis Colon Rectum, 2013, 56(4): 433-440.
27. Occhionorelli S, Tartarini D, Cappellari L, et al. Colonic stent placement as a bridge to surgery in patients with left-sided malignant large bowel obstruction. An observational study. G Chir, 2014, 35(11-12): 283-289.
28. Deans GT, Krukowski ZH, Irwin ST. Malignant obstruction of the left colon. Br J Surg, 1994, 81(9): 1270-1276.
29. Riedl S, Wiebelt H, Bergmann U, et al. Postoperative complications and fatalities in surgical therapy of colon carcinoma. Results of the German multicenter study by the Colorectal Carcinoma Study Group. Chirurg, 1995, 66(6): 597-606.
30. Sebastian S, Johnston S, Geoghegan T, et al. Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol, 2004, 99(10): 2051-2057.
31. Meisner S, Hensler M, Knop FK, et al. Self-expanding metal stents for colonic obstruction: experiences from 104 procedures in a single center. Dis Colon Rectum, 2004, 47(4): 444-450.
32. 谢正勇, 李泽航, 程黎阳, 等. 开腹术与腹腔镜治疗结直肠癌对其手术情况、术后恢复及复发转移的对比研究. 现代消化及介入诊疗, 2018, 23(3): 382-385.
33. Watt AM, Faragher IG, Griffin TT, et al. Self-expanding metallic stents for relieving malignant colorectal obstruction: a systematic review. Ann Surg, 2007, 246(1): 24-30.
34. Shimizu H, Yamazaki R, Ohtsuka H, et al. Feasibility of laparoscopic surgery after stent insertion for obstructive colorectal cancer. Asian J Endosc Surg, 2018, 11(2): 118-122.
35. Kim EJ, Kim YJ. Stents for colorectal obstruction: past, present, and future. World J Gastroenterol, 2016, 22(2): 842-852.
36. Khot UP, Lang AW, Murali K, et al. Systematic review of the efficacy and safety of colorectal stents. Br J Surg, 2002, 89(9): 1096-1102.
37. Small AJ, Coelho-Prabhu N, Baron TH. Endoscopic placement of self-expandable metal stents for malignant colonic obstruction: long-term outcomes and complication factors. Gastrointest Endosc, 2010, 71(3): 560-572.
38. Cennamo V, Fuccio L, Mutri V, et al. Does stent placement for advanced colon cancer increase the risk of perforation during bevacizumab-based therapy? Clin Gastroenterol Hepatol, 2009, 7(11): 1174-1176.
39. Manes G, de Bellis M, Fuccio L, et al. Endoscopic palliation in patients with incurable malignant colorectal obstruction by means of self-expanding metal stent: analysis of results and predictors of outcomes in a large multicenter series. Arch Surg, 2011, 146(10): 1157-1162.
40. Mabardy A, Miller P, Goldstein R, et al. Stenting for obstructing colon cancer: fewer complications and colostomies. JSLS, 2015, 19(1): e2014.
41. Huang X, Lv B, Zhang S, et al. Preoperative colonic stents versus emergency surgery for acute left-sided malignant colonic obstruction: a meta-analysis. J Gastrointest Surg, 2014, 18(3): 584-591.
42. 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.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Efficacy and safety of selective surgery after colonic stenting versus emergency surgery foracute obstructive colorectal cancer: a meta-analysis

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